The dynamic movements of the velopharyngeal sphincter are a complex motor mechanism requiring coordination between the soft palate and the lateral and posterior walls of the pharynx. Lowering the soft palate allows the oropharynx and nasopharynx to open simultaneously, facilitating normal nasal breathing. On the other hand, certain functions, such as swallowing or the pronunciation of certain phonemes, require complete or almost complete velopharyngeal closure or a modulated opening according to functional needs. Any alteration in this mechanism can have a profound effect on various functions, in particular phonation disorders (manifested by hypernasality and unintelligible speech), dysphagia and air and fluid leakage. The aim of this article is to describe the prosthetic management of a patient with a velar defect following surgical resection of a tumour process, highlighting the constraints encountered and the specific features of this clinical situation.
References
[1]
(2005). The Glossary of Prosthodontic Terms. Journal of Prosthetic Dentistry, 94, 10-92.
[2]
Abreu, A., Levy, D., Rodriguez, E., & Rivera, I. (2007). Oral Rehabilitation of a Patient with Complete Unilateral Cleft Lip and Palate Using an Implant-Retained Speech-Aid Prosthesis: Clinical Report. The Cleft Palate Craniofacial Journal, 44, 673-677. https://doi.org/10.1597/06-169.1
[3]
Agrawal, K. K., Singh, B. P., Chand, P., & Patel, C. B. S. (2011). Impact of Delayed Prosthetic Treatment of Velopharyngeal Insufficiency on Quality of Life. Indian Journal of Dental Research, 22, 356-358. https://doi.org/10.4103/0970-9290.84300
[4]
Azhari, M., Rokhssi, H., Benfdil, F., Merzouk, N., & Bentahar, O. (2017). La réhabilitation prothétique d’une perte de substance vélo-palatine: À propos d’un cas clinique. ActualitésOdonto-Stomatologiques, 286, Article No. 2. https://doi.org/10.1051/aos/2017062
[5]
Curtis, T. A., & Beumer, J. (1996). Speech, Velopharyngeal Function, and Restoration of Soft Palate Defects. In J. Beumer, T. A. Curtis, & M. T. Marunick (Eds.), Maxillofacial Rehabilitation: Prosthodontic and Surgical Considerations (pp. 304-319). Isbiyaku EuroAmerica.
[6]
Destruhaut, F., Dichamp, J., Pomar, P., Toulouse, E., & Vigarios, E. (2014). La prothèsemaxillofaciale. Memento, Éditions CdP.
[7]
Harrison, J. W. (1992). Dental Implants to Rehabilitate a Patient with an Unrepaired Complete Cleft of the Hard and Soft Palate: A Clinical Report. The Cleft Palate Craniofacial Journal, 29, 485-488. https://doi.org/10.1597/1545-1569_1992_029_0485_ditrap_2.3.co_2
[8]
Kreeft, A. M., Krap, M., Wismeijer, D., Speksnijder, C. M., Smeele, L. E., Bosch, S. D. et al. (2012). Oral Function after Maxillectomy and Reconstruction with an Obturator. International Journal of Oral and Maxillofacial Surgery, 41, 1387-1392. https://doi.org/10.1016/j.ijom.2012.07.014
[9]
Saunders, T. R., & Oliver, N. A. (1993). A Speech-Aid Prosthesis for Anterior Maxillary Implant-Supported Prostheses. The Journal of Prosthetic Dentistry, 70, 546-547. https://doi.org/10.1016/0022-3913(93)90271-o
[10]
Shifman, A., Finkelstein, Y., Nachmani, A., & Ophir, D. (2000). Speech-Aid Prostheses for Neurogenic Velopharyngeal Incompetence. The Journal of Prosthetic Dentistry, 83, 99-106. https://doi.org/10.1016/s0022-3913(00)70094-1
[11]
Sprintzen, R. J., & Bardach, J. (1995). Cleft Palate Speech Management (pp. 263-267). C.V. Mosby.
[12]
Yoshida, H., Michi, K., Yamashita, Y., & Ohno, K. (1993). A Comparison of Surgical and Prosthetic Treatment for Speech Disorders Attributable to Surgically Acquired Soft Palate Defects. Journal of Oral and Maxillofacial Surgery, 51, 361-365. https://doi.org/10.1016/s0278-2391(10)80345-3