Prosthetic Approach of Rehabilitating Patients withVelopharyngeal Insufficiency

The subject of this case study was a 43-year-old male with a hypernasality problem due to a right hemiparesis of the velum (soft palate) following a Cerebro-Vascular Accident (CVA). The patient was subjected to videofluoroscopic assessment of the soft palate and the posterior pharyngeal wall to detect and measure the existing gap causing hypernasality. The ultimate goal was to design a palatal lift to function as a static mechanical prosthesis. The existing gap was measured and a palatal lift was designed accordingly, then modified to achieve the best possible vocal resonance quality. Nasometric evaluation (measurement of the nasalance scores) was conducted pre and post palatal lift fitting. Perceptual judgment of the patient’s vocal resonance quality was also conducted pre and post palatal lift fitting by three speech-language pathologists, one dentist and two M.A. students of speech-language pathology. Post palatal lift results showed that Nasometric readings were within normal limits. Also, vocal resonance was checked and the patient achieved normal resonance. Optimal prosthetic management of the palato-pharyngeal port requires close interaction between a number of professionals (e.g.the dentist and speech pathologist and the x-ray specialist) in the use of videofluoroscopy for design, placement and modification of the prosthesis.