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Adjudication committee
- First opponent: Docent Magnus Becker, Department of Plastic and Reconstrucive Surgery, Skåne University Hospital, Sweden
- Second opponent: Docent Jan Lilja, University of Gothenburg, Sweden
- Third member and chair of the evaluation committee: Associate Professor Greg Eigner Jablonski, University of Oslo
Chair of the Defence
Head of Research Leiv Arne Rosseland, Faculty of Medicine, University of Oslo
Principal Supervisor
MD, PhD, Charles Filip, Oslo University Hospital
Summary
Velopharyngeal insufficiency (VPI) is an inability to achieve complete closure of the velopharyngeal apparatus during speech, i.e. an incomplete closure between the oral and nasal cavities, which most characteristically gives rise to hypernasal speech. The most common cause of VPI is a cleft palate.
Autologous fat transplantation to the velopharynx is a method used to treat mild VPI (paper I and II). The procedure was found to cause a long-term effect on velopharyngeal closure, suggested by a significantly reduced velopharyngeal distance measured on MRI during phonation, and an improved audible nasal emission postoperatively (paper II).
A validated quality of life questionnaire was also used to evaluate any change in patient´s quality of life after autologous fat transplantation to the velopharynx (paper I). A significant improvement of quality of life after treatment was registered.
Patients with 22q11.2 deletion syndrome (also called Di George syndrome) has a high risk to develop VPI. Patients with 22q11.2 deletion syndrome were investigated with MRI and compared to a healthy control group (paper III). Various anatomical differences in the velopharynx were found between subjects and controls, the most important regarding the levator veli palatini muscle (the main muscle involved in the velopharyngeal closure). These abnormalities in the palate and pharynx make this patients group more prone to VPI.
Patients who underwent palate repair may develop maxillary hypoplasia. In order to correct malocclusion, orthognathic surgery can be indicated. The most common procedures include maxillary advancement alone or bimaxillary surgery.
In order to evaluate the impact of orthognathic surgery on velopharyngeal function, pre- and postoperative audio recordings were evaluated; additionally, cephalometric radiographs were used to measure the differences after surgery (paper IV). Deterioration of hypernasal speech was observed in the patients who underwent maxillary advancement alone.
Additional information
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