Palatal Lift Appliance in a Case of Palatal Incompetence Secondary to Motor Neurone Disease

Velopharyngeal deficiencies (failure of the soft palate to form closure with the posterior pharyngeal wall) are challenging conditions to manage, often requiring input from several different specialties including restorative dentistry. Palatal incompetence, that is, the inability of a structurally intact palate to elevate and close the nasopharynx from the oropharynx, can result in hypernasality and air escape, which compromise speech sounds and cause swallowing difficulty. The palatal lift appliance is a prosthesis designed to elevate the palate to aid velopharyngeal closure. It has been used to manage patients with neurological disorders affecting the palate, this report presents such management in a patient with motor neurone disease.

The soft palate is the posterior muscular extension of the hard palate. Together they form the roof of the mouth and floor of nasopharynx, and have functions in respiration, speech and swallowing. The soft palate attaches to the posterior rim of the hard palate and has a posteromedial extension called the uvula. The muscles that make up the soft palate are the levator veli palatini, tensor veli palatine, masculus uvulae, palatoglossus and the palatopharyngeus. Innervation comes from the pharyngeal plexus, which takes its motor fibres from the vagus nerve and the cranial portion of the accessory nerve. In adults, the anteroposterior elevation of the soft palate to a level above the palatal plane is accompanied by an increase in length termed ‘velar stretch’, which enables contact of the posterior soft palate with the posterior and lateral pharyngeal walls. This closes the velopharyngeal complex during swallowing and speech.