Palatopharyngeal Incompetence and its Effects
- Palatopharyngeal incompetence refers to the inability to sufficiently close the port between the nasopharynx and oropharynx during speech and swallowing.
- It can result in hypernasal speech and difficulty in understanding the speaker.
- Only three English language phonemes (/m/, /n/, and /ng/) are pronounced with an open palatopharyngeal port.
- Palatopharyngeal incompetence can also lead to nasopharyngeal regurgitation of liquids or solids during swallowing.
- It should not be confused with palatopharyngeal insufficiency, which is the absence of the anatomy responsible for palatopharyngeal closure.
Function of Palatal Lift Prosthesis
- A palatal lift prosthesis physically displaces the dysfunctional soft palate to close the palatopharyngeal port and mitigate hypernasal speech.
- It also prevents nasopharyngeal regurgitation of liquids or solids during swallowing.
- The prosthesis consists of an oral component for stabilization and an oropharyngeal extension to displace the soft palate.
- Palatal lift prostheses can be interim or definitive, depending on the patient's needs.
- Interim prostheses use polymethylmethacrylate and orthodontic wire clasps, while definitive prostheses use cast metallic alloy lamina and retentive clasps.
Interim and Definitive Palatal Lift Prostheses
- Interim palatal lift prostheses are made of polymethylmethacrylate and orthodontic wire clasps.
- They adapt to the hard and soft palatal mucosal surfaces and lingual aspects of the maxillary teeth.
- The retention of an interim prosthesis depends on the presence of healthy maxillary teeth.
- Patients with partial edentulism may have less retentive predictability, especially if they lack posterior maxillary teeth.
- Patients missing anterior maxillary teeth may lack stability and retention without indirect retainers.
- Definitive palatal lift prostheses consist of a cast metallic alloy lamina covering the hard palatal mucosa and lingual aspects of the maxillary teeth.
- They incorporate retentive clasps that engage undercut dental surfaces for enhanced retention.
- The cast metallic portion retains a polymethylmethacrylate oropharyngeal section responsible for elevating the soft palate.
- The retention of a definitive prosthesis is more predictable than an interim prosthesis.
- Both definitive and interim palatal lift prostheses have current dental terminology code numbers for classification.
Palatal Lift Prosthesis Retention
- Dentoalveolar anatomy must be considered for palatal lift prosthesis retention.
- A full complement of healthy maxillary teeth offers greater assurance of retention.
- Partially edentulous patients without suitable posterior maxillary teeth have less retentive predictability.
- Missing anterior maxillary teeth can compromise stability and retention without indirect retainers.
- Patients with compromised retention may be candidates for endosseous titanium implants and abutments to improve retention.
Surgical Alternatives to Palatal Lift Prostheses
- Patients with strong gag reflexes may not tolerate palatal lift prostheses.
- Edentulous or partially edentulous patients may not have enough dental abutments for retention.
- Dental growth, exfoliation, and other dental issues can require multiple prostheses, which may be costly and time-consuming.
- Surgical tactics can be used as an alternative to prosthetic management of palatopharyngeal incompetence.
- Prosthetic management can be a substitute for surgical management when surgical contraindications are present.
- Pharyngeal flap surgery occludes the palatopharyngeal port to manage palatopharyngeal incompetence.
- The procedure maintains patencies between the nasopharynx and oropharynx for nasal respiration and resonance.
- Patients with minimal lateral pharyngeal wall adduction may not be able to close their surgically preserved palatopharyngeal ports.
- Residual palatopharyngeal incompetence may require the fabrication of palatal lift prostheses.
- Pharyngeal flap surgery is often favored as a first option for palatopharyngeal incompetence management.
- Pharyngoplasty is a surgical technique for patients with soft palatal elevation and insufficient lateral pharyngeal wall adduction.
- Incisions are made in the lateral and posterior pharyngeal walls to elevate native tissue.
- The elevated tissues, called flaps, remain pedicled to their native structures for blood flow.
- Flaps are sutured into recipient sites to provide postoperative tissue volume for palatopharyngeal closure.
- Pharyngoplasty carries similar contraindications and complications as pharyngeal flap surgery, including the risk of obstructive sleep apnea.
A palatal lift prosthesis is a prosthesis that addresses a condition referred to as palatopharyngeal incompetence. Palatopharyngeal incompetence broadly refers to a muscular inability to sufficiently close the port between the nasopharynx and oropharynx during speech and/or swallowing. An inability to adequately close the palatopharyngeal port during speech results in hypernasalance that, depending upon its severity, can render speakers difficult to understand or unintelligible. The potential for compromised intelligibility secondary to hypernasalance is underscored when consideration is given to the fact that only three English language phonemes – /m/, /n/, and /ng/ – are pronounced with an open palatopharyngeal port. Furthermore, an impaired ability to effect a closure of the palatopharyngeal port while swallowing can result in the nasopharyngeal regurgitation of liquid or solid boluses.
Palatopharyngeal incompetence should not be confused with palatopharyngeal insufficiency. While palatopharyngeal incompetence and palatopharyngeal insufficiency contribute to similar symptomatology as they relate to speech and swallowing, the former results from a hypomobility or paralysis of intact anatomy that is normally responsible for effecting palatopharyngeal closure while the latter results from a congenital or acquired absence of that anatomy. Palatal lift prostheses are designed to address palatopharyngeal incompetence. Although structurally similar to palatal lift prostheses, technically distinct soft palatal obturator prostheses or speech aid prostheses are used to address palatopharyngeal insufficiency.
A palatal lift prosthesis addresses palatopharyngeal incompetence by physically displacing the dysfunctional soft palate in the hope of closing the palatopharyngeal port enough to mitigate hypernasal speech and/or prevent nasopharyngeal regurgitation of liquids or solids during the pharyngeal phase of swallowing. A palatal lift prosthesis consists of an oral component that stabilizes and secures the prosthesis and an oropharyngeal extension that superiorly and posteriorly displaces the impaired soft palate. Palatal lift prostheses are classified as interim or definitive prostheses.
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An interim palatal lift prosthesis generally consists of two or more stainless steel wire retentive clasps embedded in polymethylmethacrylate that adapts to the hard palatal and soft palatal mucosal surfaces and the lingual aspects of the maxillary teeth. An interim palatal lift prosthesis carries a current dental terminology code number of D5958. A definitive palatal lift prosthesis generally consists of a thin cast metallic alloy lamina that covers the hard palatal mucosa and the lingual aspects of the maxillary teeth and incorporates retentive clasps that strategically engage undercut dental surfaces to enhance the retentive capacity of the prosthesis. The cast metallic portion of a definitive palatal lift prosthesis typically harbors a posterior cast metal lattice that retains a polymethylmethacrylate oropharyngeal section of the prosthesis responsible for elevating the soft palate. A definitive palatal lift prosthesis carries a current dental terminology code number of D5955. Definitive and interim palatal lift prostheses both carry current procedural terminology code numbers of 21083.
