Cleft Speech 3 - Speech Imaging

Summary

In this video, Dr. James Seaward, a pediatric plastic and cleft surgeon, discusses the evaluation process for children with cleft palates who have velopharyngeal dysfunction (VPD), affecting their speech. He explains the use of speech imaging studies, including lateral video fluoroscopy and video naso-endoscopy, to assess palate movement during speech. These studies help determine if surgery is beneficial and which type of operation is most suitable for the child. Dr. Seaward emphasizes the importance of a collaborative approach involving speech therapists and imaging data to make informed decisions about treatment.

Takeaways

• 👨‍⚕️ James Seaward is a pediatric plastic and cleft surgeon at UT Southwestern Medical Center, specialized in treating children with cleft-related speech issues.
• 🗣️ Children with clefts can have velopharyngeal dysfunction (VPD), a resonance error where too much air escapes through the nose during speech.
• 🔍 To assess VPD, speech imaging studies are conducted, including lateral video fluoroscopy and video naso-endoscopy, to observe the palate's movement during speech.
• 📹 Lateral video fluoroscopy uses x-ray technology to view the palate's side movement, helping to identify issues with the soft palate's contact with the back of the throat.
• 👄 Video naso-endoscopy involves a camera in the mouth and nose, providing direct visualization of the soft palate's movement and its ability to form an effective valve.
• 👶 The speech imaging studies help determine if surgery could benefit a child's speech and which operation might be most suitable.
• 🤝 A multidisciplinary team, including speech therapists and surgeons, evaluates the child to decide on the best course of action for speech improvement.
• 📊 The imaging studies provide valuable data on the palate's movement, gaps, and force required for an effective valve system, crucial for surgical planning.
• 🌐 For more information about James Seaward and his practice, viewers are directed to his website, www.drseaward.org.
• 🔄 In upcoming videos, Dr. Seaward will discuss the different types of speech surgeries he offers to address VPD in children.

Q & A

What is the main focus of the discussion led by James Seaward?

The main focus is on investigating children born with a cleft who struggle with speech, particularly those suspected to have velopharyngeal dysfunction (VPD), where too much air escapes from their nose when they talk.

What is velopharyngeal dysfunction (VPD)?

Velopharyngeal dysfunction (VPD) is a type of resonance error where the soft palate does not make proper contact with the back of the throat during speech, leading to excessive nasal airflow and affecting speech clarity.

What role does James Seaward play at UT Southwestern Medical Center?

James Seaward is a pediatric plastic and cleft surgeon at UT Southwestern Medical Center in Dallas, Texas, specializing in the treatment of children born with clefts.

What are the two speech imaging studies mentioned for evaluating VPD?

The two speech imaging studies mentioned are lateral video fluoroscopy and video naso-endoscopy. These studies help in assessing the movement of the palate during speech and determining the appropriate surgical intervention.

How does lateral video fluoroscopy help in evaluating a child's speech?

Lateral video fluoroscopy uses x-ray technology to observe the palate from the side as the child speaks, allowing the medical team to see the movement of the hard and soft palate and identify any issues with the valve system.

What information can video naso-endoscopy provide during a speech evaluation?

Video naso-endoscopy involves placing a small camera into the mouth and nose to directly observe the soft palate's movement. It provides detailed images of the palate's contact with the throat and can show differences in movement between the right and left sides.

Why is the speech therapist evaluation important in deciding on surgery for speech?

The speech therapist evaluation is crucial as it provides a comprehensive assessment of the child's speech patterns and difficulties. This information, combined with the findings from speech imaging studies, helps determine if surgery is beneficial and which type of surgery would be most effective.

What examples of palate movement issues are shown during the video fluoroscopy?

Examples shown include touch closure where the soft palate barely reaches the back of the throat, small and large consistent gaps, and a palate that is not moving well at all.

How does the presence of bubbles in the video naso-endoscopy indicate a problem?

Bubbles seen in the video naso-endoscopy indicate that air is escaping through the valve system, suggesting that the soft palate is not creating a proper seal against the throat, which is a sign of VPD.

What is the significance of the team approach mentioned by James Seaward?

The team approach is significant because it ensures a multidisciplinary evaluation of the child's condition. This includes input from speech therapists, surgeons, and other specialists, leading to a more informed decision on whether and what type of surgery would benefit the child's speech.

What can be expected in James Seaward's next video?

In his next video, James Seaward will discuss the different types of speech surgeries he offers, providing insight into the surgical options available for children with speech issues related to clefts.

Outlines

00:00

🗣️ Investigating Cleft Speech and VPD

Dr. James Seaward, a pediatric plastic and cleft surgeon, discusses the investigation process for children with clefts who have speech difficulties due to velopharyngeal dysfunction (VPD). He explains that after a speech pathologist suspects VPD, imaging studies are recommended to evaluate the palate's movement during speech. Two primary imaging studies are used: lateral video fluoroscopy, which involves x-ray imaging of the palate from the side as the child speaks, and video naso-endoscopy, which uses a camera to directly observe the soft palate's movement. These studies help determine if surgery could benefit the child's speech and which type of surgery might be most appropriate. Dr. Seaward emphasizes the importance of a collaborative approach involving speech therapists and imaging results to make informed decisions about treatment.

Keywords

💡Cleft

A cleft refers to a congenital condition where there is a split or opening in the lip, alveolus (the ridge of bone that holds the teeth), or palate, which can affect feeding, hearing, and speech. In the video, children born with a cleft are discussed, particularly those who struggle with speech due to issues related to the structure of their palate.

💡Velopharyngeal Dysfunction (VPD)

Velopharyngeal Dysfunction is a speech disorder characterized by the inability of the soft palate to make proper contact with the back of the throat (the pharynx) during speech, leading to nasal air escape and resonance issues. The video explains that VPD is a type of resonance error that can be suspected in children with clefts who have excessive air escaping from their nose while speaking.

💡Speech Imaging

Speech imaging is a diagnostic tool used to visualize the movement of the palate during speech. The video describes two types of speech imaging: lateral video fluoroscopy and video naso-endoscopy. These studies help determine if a child has VPD and if surgical intervention would be beneficial for their speech.

💡Lateral Video Fluoroscopy

Lateral video fluoroscopy is an x-ray test that observes the palate's movement from the side as the child speaks. This imaging technique is crucial for identifying velopharyngeal dysfunction. The video provides an example of how this test can reveal issues such as touch closure, small consistent gaps, and larger consistent gaps in the palate's movement.

💡Soft Palate

The soft palate is the rear part of the roof of the mouth that is involved in speech, swallowing, and the prevention of nasal regurgitation of food. In the context of the video, the soft palate's movement is critical for proper speech and closure of the velopharyngeal sphincter, and its dysfunction can lead to VPD.

💡Pharyngeal Flap

A pharyngeal flap is a surgical procedure mentioned in the video that involves creating a flap of tissue from the soft palate to augment the posterior pharyngeal wall, aiming to improve velopharyngeal closure and reduce nasal emission of air during speech. The video suggests that speech imaging can show the effectiveness of this procedure.

💡Resonance

Resonance in speech refers to the quality and clarity of sound produced by the vocal tract. In the video, resonance errors like VPD are discussed, where the sound is overly nasal due to improper closure of the velopharyngeal port, affecting the child's speech.

💡Speech Pathologists

Speech pathologists are healthcare professionals who assess, diagnose, and treat speech, language, voice, and fluency disorders. In the video, they play a critical role in evaluating children with clefts and suspecting VPD, recommending further investigation through speech imaging.

💡Video Naso-Endoscopy

Video naso-endoscopy is a diagnostic procedure where a small camera is placed into the nose and mouth to directly view the soft palate's movement. This imaging study is highlighted in the video as a way to observe the palate's contact with the back of the throat and to identify any gaps or improper movement patterns.

💡Surgical Intervention

Surgical intervention in the context of the video refers to operations that can help correct the structural issues causing VPD. The video discusses how speech imaging studies can inform decisions about whether surgery would be beneficial and which type of surgery is most appropriate for an individual child.

💡Cleft Team

A cleft team is a multidisciplinary group of healthcare professionals who work together to provide comprehensive care for individuals with clefts. The video mentions that speech pathologists within the cleft team are instrumental in evaluating children and recommending speech imaging studies to assess VPD.

Highlights

Investigating children with clefts and velopharyngeal dysfunction (VPD) for speech difficulties.

Introduction by James Seaward, a pediatric plastic and cleft surgeon at UT Southwestern Medical Center.

Explanation of VPD as a resonance error causing excessive nasal airflow during speech.

Speech imaging studies are used to determine if surgery could benefit a child's speech.

Speech pathologists recommend investigating palate movement during speech if VPD is suspected.

Lateral video fluoroscopy is the first imaging study, using x-rays to view palate movement from the side.

Demonstration of how the palate should move normally during speech, making good contact with the back of the throat.

Examples of how fluoroscopy can reveal problems with the soft palate's movement and closure.

The role of fluoroscopy in determining the appropriate type of surgery for individual children.

Introduction of video naso-endoscopy, the second speech imaging study, using a camera in the mouth and nose.

Direct visualization of the soft palate's movement and its contact with the throat during speech.

Examples of how naso-endoscopy can show variations in palate movement and the effectiveness of the valve system.

The importance of naso-endoscopy in assessing speech mechanisms, especially in patients with a pharyngeal flap.

Emphasis on the collaborative decision-making process involving speech therapists and imaging studies for surgical planning.

Anticipation of the next video discussing different types of speech surgeries offered.

Invitation for more information about James Seaward's practice and his approach to cleft surgery.

Transcripts

Hello

Today I would like to discuss how we investigate children born with a cleft who are struggling with their speech and whom the cleft speech

pathologists suspect have too much air escaping from their nose when they talk. I am James Seaward,

a pediatric plastic and cleft surgeon at UT Southwestern Medical Center in Dallas, Texas.

In the last videos we looked at why children born with a cleft

can have too much air coming out of the nose when they speak and that this is a type of resonance error

known as velopharyngeal dysfunction or VPD for short.

In this video, I would like to discuss the speech imaging studies

we do to work out whether a child would benefit from surgery to help with speech

and to help decide which operation is the most appropriate for that individual child.

Once the cleft team speech pathologists have evaluated the child and suspect that the child has VPD,

they will usually recommend investigating the way the palate is moving during speech with speech imaging

This speech imaging consists of two imaging studies. The first is lateral video fluoroscopy.

This is an x-ray test in which we look at the palate moving from the side as the child talks

here you can see a girl looking at some pictures to keep her head still during the study

and the machine that takes the x-ray pictures as she is talking.

If we go back to the side view of the middle of the face,

which you will remember, the images we get from fluoroscopy are very similar

You can see the hard palate between the mouth and the nose and the soft palate behind

If we now look at the soft palate as this child speaks,

you will see that it lifts nicely making good contact with the back of the throat

This is normal movement and is what I aim to achieve

Here are some examples of how this imaging can show problems with this valve system

Here is an example of touch closure where the soft palate just about reaches the back of the throat

but not with enough force to act as an effective valve

now an example of a small consistent gap, and a larger consistent gap;

and finally an example of a palate that really isn't moving well at all

The information from the study can help to show which type of surgery is most likely to help for the individual child

The other type of speech imaging is video naso-endoscopy

In this study a small camera is placed into the mouth and the nose

and we can see the soft palate moving directly

It gives us images like this

Going back to a familiar mid facial diagram the camera is about here, and it's looking at this area

which means that on the picture the back of the throat is at the top and the soft palate is at the bottom.

If we look as the child speaks, you can see the soft palate lifting against the throat and making good contact

This is a normal movement pattern.

Here is an example of a palate that is lifting but not making contact, with a large gap,

an example of a palate that is nearly making contact

but has a consistent small gap,

and an example of a palate that is just about touching but doesn't have the force required to create a good valve system.

You can see the bubbles as the air forces its way through the valve.

This study is very helpful to show differences in palate movement between the right and left sides and

to show the speech mechanism in patients who have had a pharyngeal flap

For me making a decision about whether a child would benefit from surgery for speech takes a team:

the speech therapist evaluation is very important and the information from the speech imaging video fluoroscopy and nasoendoscopy

shows whether surgery can help and which type of surgery is most likely to help the individual child.

In my next video, I'll discuss the different types of speech surgery I offer.

Thank you for watching, and if you would like any more information about me and my practice please visit my website at www.drseaward.org