Abstract:
LEARNING OBJECTIVES:After studying this article, the participant should be able to: 1. Have a clear understanding of the evolution of concepts of velopharyngeal dysfunction, especially as it relates to patients with a cleft palate. 2. Explain the subjective and objective evaluation of speech in children with velopharyngeal dysfunction. 3. On the basis of these diagnostic findings, be able to classify types of velopharyngeal dysfunction. 4. Develop a safe, evidence-based, patient-customized treatment plan for velopharyngeal dysfunction founded on objective considerations. SUMMARY:Velopharyngeal dysfunction is improper function of the dynamic structures that work to control the velopharyngeal sphincter. Approximately 30 percent of patients having undergone cleft palate repair require secondary surgery for velopharyngeal dysfunction. A multidisciplinary team using multimodal instruments to evaluate velopharyngeal function and speech should manage these patients. Instruments may include perceptual speech analysis, video nasopharyngeal endoscopy, multiview speech videofluoroscopy, nasometry, pressure-flow, and magnetic resonance imaging. Velopharyngeal dysfunction may be amenable to surgical or nonsurgical treatment methods or a combination of each. Nonsurgical management may include speech therapy or prosthetic devices. Surgical interventions could include palatal re-repair with repositioning of levator veli palatini muscles, posterior pharyngeal flap, sphincter pharyngoplasty, or soft palate or posterior wall augmentation. Treatment interventions should be based on objective assessment and rating of the movement of lateral and posterior pharyngeal walls and the palate to optimize speech outcomes. Treatment should be tailored to specific anatomical and physiologic findings and the overall needs of the patient.
journal_name
Plast Reconstr Surgjournal_title
Plastic and reconstructive surgeryauthors
Naran S,Ford M,Losee JEdoi
10.1097/PRS.0000000000003335subject
Has Abstractpub_date
2017-06-01 00:00:00pages
1343e-1355eissue
6eissn
0032-1052issn
1529-4242pii
00006534-201706000-00042journal_volume
139pub_type
杂志文章,评审abstract:BACKGROUND:Treatment of keloid scars poses a significant challenge. Assessment of treatment response and research in this area depend on the availability of objective, accurate, and reproducible outcome measures. At present, scars are assessed using subjective grading systems, or with cumbersome investigations such as ...
journal_title:Plastic and reconstructive surgery
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doi:10.1097/01.prs.0000252505.52821.76
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abstract:BACKGROUND:Craniofacial dysostosis syndromes produce multisutural synostoses combined with severe midfacial retrusion. This may cause serious functional problems, including airway obstruction, exposure of the eyes, visual pathway dysfunction, and raised intracranial pressure. Early midface advancement may be necessary ...
journal_title:Plastic and reconstructive surgery
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doi:10.1097/01.prs.0000305538.75347.52
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abstract::The literature regarding reconstruction of large scalp wounds with free tissue transfer consists mostly of case reports and small series, and none of the published reports focus on the particular problems of the oncology patient. Here the authors describe their experience with 37 flaps in 32 patients, all of whom requ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200205000-00008
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abstract::Free submandibular salivary gland transfer was investigated as a surgical method for the treatment of severe keratoconjunctivitis sicca. In an animal model, we examined the tolerance of warm ischemia of the submandibular gland. After temporary interruption of the blood supply (1 to 6 hours), the morphologic changes in...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
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更新日期:2000-09-01 00:00:00
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journal_title:Plastic and reconstructive surgery
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journal_title:Plastic and reconstructive surgery
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pub_type: 杂志文章
doi:10.1097/01.prs.0000221113.78244.8c
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
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更新日期:2005-02-01 00:00:00
abstract:BACKGROUND:Although most craniosynostoses can be determined by pattern recognition, some patients defy phenotypic diagnosis and require computed tomography to determine sutural fusions. METHODS:The authors' craniofacial database was reviewed for patients treated for craniosynostosis between 1989 and 2007. Children wit...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e31817f45f0
更新日期:2008-09-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
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更新日期:2019-02-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0000000000005370
更新日期:2019-03-01 00:00:00
abstract::The authors, a plastic surgeon (Dirnberger) and a neurologist (Becker), conducted this study after reading the article by of Bahman Guyuron et al. in the August 2000 issue of Plastic and Reconstructive Surgery (106: 429, 2000). Sixty patients were operated on between June of 2001 and June of 2002; postoperative follow...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000131906.27281.17
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND:Acellular dermal matrices have been proposed to decrease the incidence of capsular contracture in implant-based breast reconstructions. The authors have modified acellular dermal matrices with fenestrations to facilitate greater lower pole expansion and improve contour. The effect of fenestrations on the abi...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000001570
更新日期:2015-10-01 00:00:00
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pub_type: 杂志文章
doi:10.1097/PRS.0000000000004200
更新日期:2018-04-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 临床试验,杂志文章
doi:10.1097/PRS.0000000000000415
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Scleral show or ectropion is a known complication of lower eyelid surgery. It is particularly problematic after lower eyelid blepharoplasty when the orbicularis oculi muscle is transected or after other procedures are performed that denervate the lower eyelid. The purpose of this study was to determine wheth...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000186532.29557.96
更新日期:2005-11-01 00:00:00
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pub_type: 杂志文章
doi:10.1097/01.prs.0000220462.28928.83
更新日期:2006-07-01 00:00:00
abstract:BACKGROUND:The accepted surgical correction of Tessier no. 3 and no. 4 craniofacial clefts is the use of interdigitating skin flaps along the line of the facial cleft, which frequently results in unsightly facial scars, poor skin color match, and an unnatural facial expression. The authors report their technique of mid...
journal_title:Plastic and reconstructive surgery
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doi:10.1097/PRS.0b013e31824ec310
更新日期:2012-06-01 00:00:00
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journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0b013e31820063d4
更新日期:2011-01-01 00:00:00
abstract::Understanding patients' perceptions of surgical results and their impacts on quality of life is of primary importance in plastic surgery, as procedures are largely performed to improve either appearance or function. Patient-reported outcome measures are questionnaires specifically designed to quantify aspects of healt...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
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abstract::Soft-tissue injuries involving the dorsum of the hand and foot continue to pose complex reconstructive challenges in terms of function and contour. Requirements for coverage include thin, vascularized tissue that supports skin grafts and at the same time provides a gliding surface for tendon excursion. This article re...
journal_title:Plastic and reconstructive surgery
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doi:10.1097/00006534-200008000-00013
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更新日期:2012-06-01 00:00:00
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pub_type: 杂志文章
doi:
更新日期:1977-04-01 00:00:00
abstract:BACKGROUND:The psychosocial benefits of postmastectomy breast reconstruction are well established; however, health care barriers persist. The authors evaluated statewide patient population to further identify obstacles to reconstruction. METHODS:A linked data set combining the North Carolina Central Cancer Registry wi...
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更新日期:2016-08-01 00:00:00
abstract:LEARNING OBJECTIVES:After studying this article, the participant should be able to: 1. Understand the difference between battery and assault in U.S. law and the concepts of the phrase "child abuse" and "elder abuse." 2. Understand that state statutes vary and can define abuse narrowly or with great specificity, and tha...
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pub_type: 杂志文章,评审
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更新日期:2006-08-01 00:00:00
abstract::As the inclusion criteria for breast conservation therapy have continued to evolve to include lower quadrant tumors, very large breasts, and central tumors, the potential for significant disfigurement after breast conservation therapy has also increased. This has led some centers to develop coordinated oncology-plasti...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
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更新日期:2003-03-01 00:00:00
abstract:BACKGROUND:Although various salvage methods have been proposed to treat intraretinal artery hyaluronic acid embolism, their applications are still limited by various factors. The authors investigated the effectiveness of intravenous hyaluronidase with urokinase for resolving retinal artery hyaluronic acid embolism. ME...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
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更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to investigate the correlation between quantitative measures of academic productivity and academic rank among full-time academic plastic surgeons. METHODS:Bibliometric indices were computed for all full-time academic plastic surgeons in the United States. The primary study vari...
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pub_type: 杂志文章
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更新日期:2015-09-01 00:00:00