The Influence of Head Position Upon Velopharyngeal Closure

Abstract

There is general agreement in the literature to the effect that the ability to achieve velopharyngeal closure is highly correlated with speech adequacy in patients with cleft palate (8—11). Brandt and lVlor-ris (I) have suggested that " as velopharyngeal opening increases, the number of articulation errors increases in a proportional or perhaps lin— ear manner ". On the other hand, clinicians are often faced with the dilemma of a patient who has perceptible hypernasality in his speech but whose cine-radiogram in lateral View would indicate that closure is being achieved. One possible explanation for this condition is that there is velopharyngeal opening at sites other than those Visible on the radio— gram. A second possibility is that there is variation in the ability of the structures to close off the nasal port and that the position of the head may contribute to that variation. The work of Lloyd, Pruzansky, and Subtelny (3) suggests that the extended head position results in a somewhat deeper pharynx than when the head is in the Frankfort plane. This being true, velopharyngeal closure viewed from an upright lateral position may yield results valid only for that position. Inability to achieve closure in other positions may be related to hypernasal speech. The question posed in this study was: Will modifying the head p0si— tion in such a way as to impose greater demands upon the velopharyngeal mechanism yield additional information about the integrity of function? Procedure SUBJECTS. Subjects were 101 children with surgically repaired cleft palates. They ranged in age from three years, two months, to fifteen years, four months, with a mean age of eight years, ten months. There were 32 females with a mean age of nine years, one month, and 69 males with a mean age of eight years, ten months. Bilateral and left and right unilateral clefts of the lip and palate, incomplete clefts of the hard and soft palate, and clefts of the soft palate only were included in the sample. This information is summarized in Table 1.