ASSESSMENT OF THE VELOPHARYNGEAL SPHINCTER AND ITS ROLE IN THE SPEECH OF PATIENTS WITH CLEFT LIP AND PALATE

Abstract

The cleft lip and palate are congenital anomalies with different dimensions; their existence alters the facial aesthetics and many orofacial functions as well. They characterize with a discontinuity of the lip, hard and soft palate and the alveolar ridge. The gravity of the clinical picture can be detennined by the lack of continuity in the skin tissue, muscles and bones, which can be manifested with a mild form of lip distortion, severe bilateral cleft lip, palate, and alveolar bone and the most severe - oblique facial cleft. The clefts can be of different dimensions; still, regardless of the size, the articulatory speech is rendered more difficult due to the constant communication between the oral and nasal cavity. Every child born with a cleft palate has dysfunction of the velopharyngeal sphincter leading to pathology of the verbal communication. The velopharyngeal sphincter is a tridimensional muscle area between the oral and nasal cavity. It is built by the lateral and posterior pharyngeal wall and the soft palate. The role of the velopharyngeal sphincter is to separate the oral from the nasal cavity, and, in that way, enable normal speech and swallowing, that is, prevent the air from escaping through the nose instead of the mouth. The speech of children with cleft is usually accompanied by a nasal sound that is associated with the velopharyngeal insufficiency (weak function of the soft palate). When the soft palate does not close completely the airflow through the nose, air passes through the thin passage and nasal speech is heard. Today, one of the techniques used to assess the articulatory function of the oropharyngeal region, both in normal and pathological cases, is the magnetic resonance. Compared to other techniques, it has more advantages due to its non-invasiveness, non-radioactivity and the fact that it is video fluoroscopic. It is used for obtaining dynamic pictures while in motion, the so called, magnetic resonance imaging.