Kaoru Ibuki

Visual training for velopharyngeal closure in cleft palate patients; a fihrescopic procedure (preliminary report)

Velopharyngeal closure in various tasks was examined in 59 cleft palate patients with persistent velopharyngeal incompetence using nasopharyngeal fibrescopic (NPF) examination. The degree of velopharyngeal closure was analyzed according to the categories reported previously by Yamaoka (1973) and Matsuya et al. (1979). The NPF self-training system was developed and applied to those patients so as to investigate a longitudinal effect of the NPF in velopharyngeal closure mechanism. The training was performed every two weeks for nearly one year. The results indicated that the patient who showed complete velopharyngeal closure during blowing and/or several productions of speech samples could attain a much better improvement in all speech samples after one year of self-training. On the other hand, the patients who did not show complete velopharyngeal closure during all tasks, failed to improve the velopharyngeal closing mechanism. The ability to close the velopharynx during swallowing was seen in all patients examined. However, it appeared to have nothing to do with the prognosis of velopharyngeal closure. The data suggested that the NPF self-training system provided a strong neuro-muscular signal for velopharyngeal movement. Besides, it was considered that the NPF was a useful tool for activation of velopharyngeal activity by way of visual feed-back control.

Peripheral Facial Palsy Accompanied with the Systemic Disease

In the entity of the peripheral facial palsies, there are idiopathic, otitic, traumatic palsy, Ramsay Hunts syndrome, and others. The causes of the facial palsies were due to the disturbance of microcirculation and the bleeding in Fallopian canal, infection of bacteria and virus, the direct damage of the facial nerve and etc..Some of them occur accompanying with the systemic disease. We reported 8 cases of the facial palsies which were accompanied with the systemic disease. These systemic disease were diabetes mellitus, sarcoidosis, aseptic and carcinomatous meningitis, systemic lupus erythematosus, aplastic anemia, and pregnancy. The facial palsies accompanied with diabetes mellitus and pregnancy are due to the disturbance of microcirculation (anoxia, ischemia, microembolism). As sarcoidosis sometimes involves in degeneration of myelin, and aseptic meningitis and infectious mononucleosis are viral infection of seventh nerve, these cause probably a neuritis or a ganglionitis. The palsy of carcinomatous meningitis is rare, but if initial symptom is only facial palsy, this palsy should be differentiated from idiopathic facial palsy (Bells palsy).As aplastic anemia causes the tendency of bleeding, this palsy occurs from the bleeding in Fallopian canal. One case of the facial palsy accompanying the aplasic anemia revealed the bleeding in Fallopian canal by autopsy. The importance of systemic disease as a possible cause of idiopathic facial palsy was emphasized.