The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association · 2019
Deglutition in Patients With Hypernasality Associated With Unilateral Cleft Lip and Palate Evaluated With High-Resolution Manometry.
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Kallusky Johanna, Zimmerer Rüdiger, Tavassol Frank, Gellrich Nils-Claudius, Ptok Martin, Jungheim Michael
Аннотация
OBJECTIVE: To evaluate pharyngeal pressure profiles during swallowing in patients with unilateral cleft lip and palate (UCLP) and identify compensation mechanisms.
DESIGN: Prospective experimental study.
SETTING: University Hospital and Medical School.
PARTICIPANTS: Ten volunteers and 10 patients with nonsyndromic repaired UCLP with hypernasality (age: 19-27 years, 5 females and 5 males per group) were included.
INTERVENTIONS: All participants swallowed 2 and 10 mL of water and underwent high-resolution manometry (HRM).
MAIN OUTCOME MEASURES: Pharyngeal and upper esophageal sphincter (UES) parameters were measured using HRM. Student t test was used for statistical intergroup comparisons. Additionally, the Sydney Swallowing Questionnaire (SSQ) was used as a subjective measure.
RESULTS: Patients exhibited reduced velopharyngeal closing pressure and velopharyngeal and tongue base (TB) region contraction times, compared to volunteers (P < .05). The UES opening and closing functions did not change. The SSQ revealed nasal regurgitation in some patients.
CONCLUSIONS: In patients with UCLP, velopharyngeal region alterations are caused by impaired muscle force and function. The reduced TB contraction time may be a compensation mechanism allowing bolus transportation without nasal regurgitation. However, deglutition is not completely altered since UES function remains normal. Future studies will need to reveal at which point a decrease in velopharyngeal closing pressure will result in velopharyngeal insufficiency.
DESIGN: Prospective experimental study.
SETTING: University Hospital and Medical School.
PARTICIPANTS: Ten volunteers and 10 patients with nonsyndromic repaired UCLP with hypernasality (age: 19-27 years, 5 females and 5 males per group) were included.
INTERVENTIONS: All participants swallowed 2 and 10 mL of water and underwent high-resolution manometry (HRM).
MAIN OUTCOME MEASURES: Pharyngeal and upper esophageal sphincter (UES) parameters were measured using HRM. Student t test was used for statistical intergroup comparisons. Additionally, the Sydney Swallowing Questionnaire (SSQ) was used as a subjective measure.
RESULTS: Patients exhibited reduced velopharyngeal closing pressure and velopharyngeal and tongue base (TB) region contraction times, compared to volunteers (P < .05). The UES opening and closing functions did not change. The SSQ revealed nasal regurgitation in some patients.
CONCLUSIONS: In patients with UCLP, velopharyngeal region alterations are caused by impaired muscle force and function. The reduced TB contraction time may be a compensation mechanism allowing bolus transportation without nasal regurgitation. However, deglutition is not completely altered since UES function remains normal. Future studies will need to reveal at which point a decrease in velopharyngeal closing pressure will result in velopharyngeal insufficiency.