1
|
Marston AP, Tollefson TT. Update on using buccal myomucosal flaps for patients with cleft palate and velopharyngeal insufficiency: primary and secondary interventions. Curr Opin Otolaryngol Head Neck Surg 2024:00020840-990000000-00129. [PMID: 38837190 DOI: 10.1097/moo.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
PURPOSE OF REVIEW This review aims to examine the indications and anatomical circumstances for when to optimally incorporate buccal myomucosal flaps (BMFs) into palatal surgical reconstruction. RECENT FINDINGS Studies examining outcomes following primary cleft palate repair with incorporation of BMF have demonstrated excellent speech outcomes and low rates of fistula. Furthermore, some reports cite an association of buccal flap use with reduced midface hypoplasia and the need for later orthognathic surgery. When used for secondary speech surgery, BMFs have been shown to lead to speech improvements across multiple outcome measures. Advantages of BMF techniques over conventionally described pharyngeal flap and pharyngoplasty procedures include significant lengthening of the velum, favorable repositioning of the levator muscular sling, and lower rates of obstructive sleep apnea. SUMMARY Although the published data demonstrate excellent outcomes with use of BMFs for primary and secondary palatal surgery, there are limited data to conclude superiority over the traditional, more extensively investigated surgical techniques. The authors of this review agree with the evidence that BMF techniques can be useful in primary palatoplasty for congenitally wide clefts, secondary speech surgery for large velopharyngeal gaps, and/or in individuals with a predisposition for airway obstruction from traditional approaches.
Collapse
Affiliation(s)
- Alexander P Marston
- University of California Davis Health, Department of Otolaryngology - Head and Neck Surgery, Sacramento, California, USA
| | | |
Collapse
|
2
|
Long BD, Petersson RS. Primary Cleft Palate Repair. Facial Plast Surg Clin North Am 2024; 32:55-62. [PMID: 37981416 DOI: 10.1016/j.fsc.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
There are several factors to consider when planning cleft palate repair. It is important to review the patient's associated comorbidities, as they impact decisions on perioperative management and family counseling. Many comorbidities change the risk of postoperative airway obstruction, velopharyngeal insufficiency, or fistula formation. It is also critical to determine the type of cleft palate to be addressed, as this influences the decision on which technique is most appropriate for optimal patient outcome. Common surgical techniques for palatoplasty are reviewed in detail and outcomes are discussed as it relates to various techniques. Intraoperative photographs are included to detail the procedures.
Collapse
Affiliation(s)
- Barry Daniel Long
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University SOM, Richmond, VA, USA
| | - Rajanya Shah Petersson
- Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University SOM, Richmond, VA, USA; Department of Otolaryngology/Head and Neck Surgery, Children's Hospital of Richmond at VCU, Richmond, VA, USA.
| |
Collapse
|
3
|
Morrison KA, Park J, Rochlin D, Lico M, Flores RL. Anatomical Study of Domain Rescue of Palatal Length in Patients With a Wide Cleft Palate: Buccal Flap Reconstruction in Primary Palatoplasty. Cleft Palate Craniofac J 2024; 61:103-109. [PMID: 35918811 DOI: 10.1177/10556656221117930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study characterizes the potential loss of velar length in patients with a wide cleft and rescue of this loss of domain by local flap reconstruction, providing anatomic evidence in support of primary lengthening of the soft palate during palatoplasty. METHODS A retrospective review was conducted of all patients with a cleft palate at least 10mm in width, who underwent primary palatoplasty with a buccal flap prior to 18 months of age over a 2-year period. All patients underwent primary palatoplasty with horizontal transection of the nasal mucosa, which was performed after nasal mucosa repair, but prior to muscular reconstruction. The resulting palatal lengthening was measured and the mucosal defect was reconstructed with a buccal flap. RESULTS Of the 22 patients included, 3 (13.6%) had a history of Pierre Robin sequence, and 5 (22.7%) had an associated syndrome. No patients had a Veau I cleft, 7 (31.8%) had a Veau II, 12 (54.5%) had a Veau III, and 3 had (13.6%) a Veau IV cleft. All patients had a right buccal flap during primary palatoplasty. The mean cleft width at the posterior nasal spine was 10.6 ± 2.82mm, and mean lengthening of the velum after horizontal transection of the nasal mucosa closure was 10.5 ± 2.23mm. There were 2 (9.1%) fistulas, 1 (4.5%) wound dehiscence, 1 (4.5%) 30-day readmission, and no bleeding complications. CONCLUSIONS Patients with a wide cleft palate have a potential loss of 1cm velar length. The buccal flap can rescue the loss of domain in palatal length, and potentially improve palatal excursion.
Collapse
Affiliation(s)
| | - Jenn Park
- NYU Langone Health, New York, NY, USA
| | | | | | | |
Collapse
|
4
|
Zhang Y, Zhang J, Li W, Yin H, He L. Automatic Detection System for Velopharyngeal Insufficiency Based on Acoustic Signals from Nasal and Oral Channels. Diagnostics (Basel) 2023; 13:2714. [PMID: 37627973 PMCID: PMC10453249 DOI: 10.3390/diagnostics13162714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Velopharyngeal insufficiency (VPI) is a type of pharyngeal function dysfunction that causes speech impairment and swallowing disorder. Speech therapists play a key role on the diagnosis and treatment of speech disorders. However, there is a worldwide shortage of experienced speech therapists. Artificial intelligence-based computer-aided diagnosing technology could be a solution for this. This paper proposes an automatic system for VPI detection at the subject level. It is a non-invasive and convenient approach for VPI diagnosis. Based on the principle of impaired articulation of VPI patients, nasal- and oral-channel acoustic signals are collected as raw data. The system integrates the symptom discriminant results at the phoneme level. For consonants, relative prominent frequency description and relative frequency distribution features are proposed to discriminate nasal air emission caused by VPI. For hypernasality-sensitive vowels, a cross-attention residual Siamese network (CARS-Net) is proposed to perform automatic VPI/non-VPI classification at the phoneme level. CARS-Net embeds a cross-attention module between the two branches to improve the VPI/non-VPI classification model for vowels. We validate the proposed system on a self-built dataset, and the accuracy reaches 98.52%. This provides possibilities for implementing automatic VPI diagnosis.
Collapse
Affiliation(s)
- Yu Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
| | - Jing Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
| | - Wen Li
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
| | - Heng Yin
- West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;
| | - Ling He
- College of Biomedical Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (J.Z.); (W.L.)
| |
Collapse
|
5
|
Long-term speech outcome in patients with Robin sequence after cleft palate repair and tongue-lip adhesion: A 21-year retrospective analysis. J Craniomaxillofac Surg 2023:S1010-5182(23)00012-4. [PMID: 37117117 DOI: 10.1016/j.jcms.2023.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/21/2022] [Accepted: 01/22/2023] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to assess the effect of tongue-lip adhesion (TLA) on the long-term speech and articulation outcomes of patients with Robin sequence (RS) after cleft palate repair. Outcomes were compared to those in patients with RS who required positioning alone and to patients with isolated cleft palate (ICP). All consecutive patients with RS (with or without TLA) versus isolated cleft palate (ICP) who underwent cleft palate repair were retrospectively reviewed. Speech and articulation included all assessments between the age of 3-6 years. Secondary speech operations, velopharyngeal insufficiency (VPI), hypernasality, and articulation errors by cleft-type characteristics (CTC), including 4 categories (passive), non-oral, anterior-oral, and posterior-oral. A total of 41 RS patients and 61 ICP patients underwent repair with sufficient follow-up. Of them, 23 patients underwent a TLA at median age of 12 days. Rates of hypernasality (p = 0.004), secondary speech operations (p = 0.004), and posterior oral CTC (p = 0.042) were higher in RS compared to ICP. Isolated RS had speech outcomes similar to those of ICP; however, syndromic RS patients needed more secondary speech operations compared to isolated RS (p = 0.043). TLA-RS patients did not demonstrate differences in speech outcomes or any CTCs (all p > 0.05) compared to non-TLA-RS patients, except for the anterior oral CTC (74% TLA-RS vs 28% non-TLA-RS, p = 0.005). Within the limitations of the study, it seem that TLA does not affect long-term velopharyngeal function in patients with RS. However, TLA-RS patients demonstrated higher rates of anterior-oral CTC, which might be related to a different positioning of the tongue after TLA. Every effort should be taken to treat patients with RS conservatively instead of with TLA because of this demonstrated a negative effect on one type of articulation error. However, if conservative therapy fails, a TLA is still a valuable adjunct in the treatment of RS, and cleft speech pathologists who treat such patients should be more aware of this phenomenon in order to improve long-term articulation outcomes.
Collapse
|
6
|
Garland K, Dworschak-Stokan A, Matic D. Patient and Surgical Factors that Affect Development of Velopharyngeal Insufficiency. J Plast Reconstr Aesthet Surg 2022; 75:3813-3816. [DOI: 10.1016/j.bjps.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/23/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
|
7
|
Speech Development in Cleft Palate with and without Robin Sequence. Plast Reconstr Surg 2021; 149:443-452. [PMID: 34898524 DOI: 10.1097/prs.0000000000008730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Robin sequence is defined as the triad of micrognathia, glossoptosis, and upper airway obstruction. In up to 85 percent, it is associated with cleft palate. Many studies have reported worse speech development in Robin sequence children after cleft palate repair. The authors investigated speech development in isolated Robin sequence with cleft palate versus children with cleft palate only at the age of 5 to 6 years. METHODS All Robin sequence children were treated with the Tübingen palatal plate after birth. Data were collected using the German version of the Great Ormond Street Speech Assessment. Audio and video recordings were reviewed and analyzed separately by two blinded senior phoniatricians based on the German version of the Universal Reporting Parameters for Cleft Palate Speech, and scored to enable comparability of speech outcomes. RESULTS Forty-four children (Robin sequence, n = 22; cleft palate only, n = 22) were included. Robin sequence children were significantly older at surgery (11.8 months versus 7.1 months; p < 0.001) but younger at study (70.5 months versus 75.2 months; p = 0.035). They also had more severe cleft of the palate (p = 0.006). All children studied showed good to very good speech development without serious impairment. None of the reported parameters on the German version of the Universal Reporting Parameters for Cleft Palate Speech showed significant group differences; the median total score in the Robin sequence group was 23 (interquartile range, 16.5 to 27.5) versus 19 (interquartile range, 17 to 23) in the cleft palate-only group. Statistical analysis revealed no significant effect of group (Z = -1.47; p = 0.14). CONCLUSIONS No group differences in speech development were found at age 5 to 6 years. Isolated Robin sequence does not necessarily represent a risk for impaired speech development. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
|
8
|
The Smile Index: Part 3. A Simple, Prognostic Severity Scale for Unilateral Cleft Palate. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3870. [PMID: 34703715 PMCID: PMC8542126 DOI: 10.1097/gox.0000000000003870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
Background Unilateral cleft palates have a large spectrum of variability. Key morphologic factors such as cleft width and palatal length are not represented in current classification systems. Palate length and velopharyngeal port size are clinically linked to speech outcomes, as the soft palate must close the posterior pharynx for proper phonation. This study investigates the relationship between objective preoperative measures and postoperative velopharyngeal port size, to define a reproducible severity scale. Methods Surgical data were prospectively collected from unilateral cleft palate patients in Morocco, Bolivia, Vietnam, and Madagascar. Key measurements were cleft width and palate width at the hard-soft palate junction, alveolar cleft width, vertical alveolar discrepancy, velopharyngeal port size. Cleft width ratio (CWR) was defined as the width of the cleft at the hard-soft junction, divided by the palate width. Results Seventy-six patients were evaluated. Thirty-one had complete clefts and average age at surgical repair was 2.9 years. Mean CWR was 0.50 ± 0.12. Palate length was increased by an average of 2.2 mm (11%) after palatoplasty. Multivariate analysis determined greater CWR and larger preoperative velopharyngeal ports were significantly correlated with a smaller percent change in palate length after palatoplasty (P < 0.01). Conclusions A wider palatal cleft decreases the surgeon's ability to decrease velopharyngeal port size through palatoplasty. Given the ease of measurement even in low-resource settings, CWR may be a valuable tool for setting expectations for speech results, modifying surgical technique, and correlating future speech outcomes in evidence-based cleft care.
Collapse
|
9
|
Liu C, Guo C, Shi B, Zheng Q, Li J. Preoperative pharyngeal depth is associated with postoperative velopharyngeal function following primary cleft palate repair at the age of five and above. J Craniomaxillofac Surg 2021; 50:93-97. [PMID: 34625372 DOI: 10.1016/j.jcms.2021.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 06/23/2021] [Accepted: 09/26/2021] [Indexed: 02/08/2023] Open
Abstract
To determine prognostic factors for postoperative velopharyngeal function following the primary cleft palate repair at the age of five and above. This study reviewed patients with cleft palate who had undergone Furlow palatoplasty at age 5 or older from 2009 to 2014. We obtained intraoperative measurements, including velar length, pharyngeal depth, cleft width, maxillary width, cleft palate index (cleft width/maxillary width) and palatopharyngeal ratio (velar length/pharyngeal depth), as well as speech evaluation results at least 1 year after surgery. Logistic regression and retrospective analyses were performed to determine factors associated with speech performance after the primary cleft palate repair. Among the six intraoperative measurements of velopharyngeal morphology, only pharyngeal depth was incorporated into the regression model, and was found to have an inverse association with postoperative velopharyngeal function, Exp (B) 0.883 (95% CI 0.798-0.976). Moreover, a pharyngeal depth greater than 16 mm was significantly associated with a higher risk of postoperative velopharyngeal insufficiency (P < 0.01). Pharyngeal depth is potentially a prognostic indicator for the primary management of cleft palate in older patients. Pharyngoplasty may need to be considered when the pharyngeal depth is large and the patient's access to surgery is limited.
Collapse
Affiliation(s)
- Chuxian Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China; Department of Stomatology, Changhai Hospital, Shanghai, 200433, PR China
| | - Chunli Guo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China
| | - Bing Shi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China
| | - Qian Zheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China
| | - Jingtao Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, PR China.
| |
Collapse
|
10
|
Evans SS, Bly RA, Paulsgrove K, Perkins JA, Sie K. Predictors of Success After Furlow Palatoplasty for Repair of Cleft Palate: Does Syndrome Matter? Otolaryngol Head Neck Surg 2021; 166:844-849. [PMID: 34491144 DOI: 10.1177/01945998211038928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine predictors of success following Veau 1 and 2 cleft palate repair in patients with and without syndromes. STUDY DESIGN Retrospective review of prospectively collected data. SETTING Tertiary care children's hospital. METHODS All children <18 months of age undergoing Furlow palatoplasty for Veau 1 and 2 cleft repair between 2000 and 2014 with postoperative perceptual speech assessment (PSA). RESULTS In total, 368 consecutive patients were identified; 95 were excluded, resulting in 273 patients. Median age at surgery was 13.0 months (interquartile range [IQR], 11-15 months) with postoperative PSA at a median of 32.3 months (IQR, 26.3-44.5 months). Fifty patients (18.3%) had syndrome diagnosis; 59 patients (21.6%) had nonsyndromic Robin sequence. Velopharyngeal insufficiency (VPI) occurred in 27 patients (10.5%); 13 underwent secondary speech surgery. Cleft-related speech errors occurred in 46 patients (17.6%). Non-cleft-related speech errors occurred in 155 patients (59.6%) and reduced intelligibility in 127 patients (47.9%). Oronasal fistula occurred in 23 patients (8.8%) and was exclusive to Veau 2 clefts. In multivariate analysis, age >13 months at palatoplasty demonstrated a 6-fold higher rate of VPI (hazard ratio [HR], 6.64; P < .01), worse speech outcomes (HR, 6.04; P < .01; HR, 1.60; P < .01; HR, 1.57; P = .02), and greater speech therapy utilization (HR, 2.18; P < .01). CONCLUSION VPI occurred in 10% of patients undergoing Furlow palatoplasty repair of Veau 1 or 2 clefts. Age <13 months at palatoplasty was associated with improved speech outcomes and lower VPI incidence (2.8% vs 16.2%). Syndromic diagnosis was associated with noncleft speech errors and reduced intelligibility on univariate analysis but not velopharyngeal function after palatoplasty.
Collapse
Affiliation(s)
- Sean S Evans
- Otolaryngology Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Randall A Bly
- Otolaryngology-Head and Neck Surgery, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kaylee Paulsgrove
- Speech and Language Services, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jonathan A Perkins
- Otolaryngology-Head and Neck Surgery, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kathleen Sie
- Otolaryngology-Head and Neck Surgery, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| |
Collapse
|
11
|
van Eeden S, Wren Y, McKean C, Stringer H. Early Communication Behaviors in Infants With Cleft Palate With and Without Robin Sequence: A Preliminary Study. Cleft Palate Craniofac J 2021; 59:984-994. [PMID: 34259062 PMCID: PMC9272514 DOI: 10.1177/10556656211031877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the early communication behaviors in infants with nonsyndromic isolated cleft palate (iCP) and Robin sequence (RS). DESIGN Group comparison using parent report. PARTICIPANTS There were 106 participants included in this study. Two groups were selected from the UK Cleft Collective resource. Parents had completed the Language ENvironment Analysis Developmental Snapshot questionnaire when their child turned 13 months. There were 78 participants in the iCP group and 28 in the RS group. MAIN OUTCOME MEASURE(S) Total number of communication behaviors reported on the questionnaire. Subdomains for expressive and receptive language and social communication behaviors were also analyzed. RESULTS There were no statistically significant group differences. Parents of infants with RS reported fewer later communication behaviors compared to the iCP group. Infants in both groups had fewer communication behaviors compared to the normative sample. Across the whole sample, post hoc analysis revealed a significant correlation between severity of the cleft and social communication behaviors and expressive but not receptive language. Infants with a cleft of the hard and soft palate were more likely to be in the RS group (odds ratio: 7.04 [95% CI: 1.55-32.04]; P = .01). CONCLUSIONS Both groups reported similar levels of early communication. Some divergence of more complex language skills was seen, although there were no significant group differences. A relationship with the diagnosis of a cleft of the hard or soft palate with expressive language behaviors was found. Further study into the impact of cleft severity on early speech development and the relationship with later language skills is needed along with longitudinal follow-up of this population.
Collapse
Affiliation(s)
- Stephanie van Eeden
- School of Education, Communication and Language Sciences, 5994Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Yvonne Wren
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, United Kingdom.,1980University of Bristol, Bristol, United Kingdom
| | - Cristina McKean
- School of Education, Communication and Language Sciences, 5994Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen Stringer
- School of Education, Communication and Language Sciences, 5994Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
12
|
Leclerc JE, Gilbert F, McConnell ÉM, Beaudoin E, Bouchard J, Simonyan D. Furlow Palatoplasty: Should We Also Focus on the Size of the Nasopharynx? Cleft Palate Craniofac J 2021; 58:1348-1360. [PMID: 33631972 DOI: 10.1177/1055665620987684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES (1) To determine the incidence rate of velopharyngeal dysfunction (VPD) according to 7 speech criteria post-Furlow palatoplasty. (2) To find an anatomical measurement of the cleft palate (or combination of measurements) associated with the occurrence of VPD. STUDY DESIGN Retrospective cohort study. PARTICIPANTS AND METHODS Fifty-six patients with cleft palate ± cleft lip underwent palatoplasty with the Furlow technique at the age of 10 months. Pre-and post-palatoplasty cleft palate measurements were collected during the procedure. Three blinded speech-language pathologists (SLPs) retrospectively scored the patients from the chart data at age 4. Student t test and receiver operating characteristic curve analysis were used to evaluate the association and predictive capacity between cleft measurements and parameters (M&P) with all VPD criteria. RESULTS The SLPs found an incidence of VPD according to 7 criteria: hypernasality (11%), audible nasal emission (4%), nasal rustle (14%), compensatory errors (4%), impairment of speech understandability (7%), and impairment of speech acceptability (16%). The SLPs recommended a secondary surgical procedure in 5 patients (9%). A statistically significant association was found between, respectively, 17 and 5 M&P and the occurrence of compensatory errors and audible nasal emission. Our data suggest that the length of the cleft, the cleft area, and the postoperative transversal size of the nasopharynx are the best indicators of the future positivity of VPD criteria. CONCLUSION The size of the postoperative transverse nasopharyngeal area during the primary cleft palate procedure may become the focus of the next generation of cleft surgeons to reduce the incidence of VPD.
Collapse
Affiliation(s)
- Jacques E Leclerc
- Department of Otolaryngology-Head and Neck Surgery, Centre hospitalier universitaire de Quebec - Université Laval, Quebec, Canada
| | - Francis Gilbert
- Department of Otolaryngology-Head and Neck Surgery, Université Laval, Quebec, Canada
| | - Élisa-Maude McConnell
- Department of Speech-Language Pathology, Centre hospitalier universitaire de Québec-Université Laval, Quebec, Canada
| | - Ericka Beaudoin
- Department of Speech-Language Pathology, Centre hospitalier universitaire de Québec-Université Laval, Quebec, Canada
| | - Johanie Bouchard
- Department of Speech-Language Pathology, Centre hospitalier universitaire de Québec-Université Laval, Quebec, Canada
| | - David Simonyan
- Statistical and Clinical Research Platform, Centre hospitalier universitaire de Quebec Research Center-Université Laval, Quebec, Canada
| |
Collapse
|
13
|
Ahmed MK, Maganzini AL, Marantz PR, Rousso JJ. Risk of Persistent Palatal Fistula in Patients With Cleft Palate. JAMA FACIAL PLAST SU 2015; 17:126-30. [DOI: 10.1001/jamafacial.2014.1436] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mairaj K. Ahmed
- Department of Dentistry/Oral and Maxillofacial Surgery and Department of Surgery, Mount Sinai Icahn School of Medicine, New York, New York
- Hudson Valley Cleft/Craniofacial Care PC, Harriman, New York
| | - Anthony L. Maganzini
- Department of Dentistry, Montefiore Medical Center, Bronx, New York
- currently in private practice in New York, New York
| | - Paul R. Marantz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Joseph J. Rousso
- Division of Facial Plastic and Reconstructive Surgery, The New York Eye and Ear Infirmary of Mount Sinai, New York, New York
- Mount Sinai Icahn School of Medicine, New York, New York
| |
Collapse
|