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Ben Slama N, Maquet C, Trost O, Leca JB. Pharyngeal flap in velopharyngeal insufficiency: Proposal of an algorithm in a series of 31 patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023:101535. [PMID: 37307914 DOI: 10.1016/j.jormas.2023.101535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 06/09/2023] [Indexed: 06/14/2023]
Abstract
This study evaluated the results of a reproductible protocol indicating the need for a pharyngeal flap in children with cleft palate and velopharyngeal insufficiency (VPI). A retrospective review of all patients operated for a pharyngeal flap between 2010 and 2019 in our center was conducted. After exclusion of patients with primary VPI or residual fistulas, 31 patients' data were analyzed. Our main outcome measure was the improvement of the Borel Maisonny Classification (BMC) by at least 1 rank. Further analysis was made to evaluate the impact of age, type of cleft, and BMC before surgery on the gain in the velopharyngeal function. Of the 31 patients, success was achieved in 29 (93.5%, p<0.005). There was no significant correlation between age and gain in the velopharyngeal function (p = 0.137). There was no significant correlation between type of cleft and gain in the velopharyngeal function (p = 0.148). There was a significant correlation observed between the starting classification and gain in velopharyngeal function. The gain observed was greater as the initial velopharyngeal function was worse (p = 0.035). The use of an algorithm combining clinical assessment with a standardized classification of the velopharyngeal function proved to be a reliable tool for the indication of surgery in patients with VPI. A close follow up is essential in a multidisciplinary team.
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Affiliation(s)
- N Ben Slama
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen 76000, France.
| | - C Maquet
- Department of Otorhinolaryngology-Head and Neck Surgery, Rouen University Hospital, Rouen 76000, France
| | - O Trost
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen 76000, France; Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen-Normandie University, 22 Boulevard Gambetta, Rouen 76183, France
| | - J B Leca
- Department of Pediatric Surgery, Clinique Chirurgicale et Infantile, CHU Charles Nicolle, Rouen, France
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Sanquer E, Hennocq Q, Picard A, Bucur-Girard A, Kadlub N, Neiva-Vaz C. Criteria for early and late velopharyngoplasty in 61 children with cleft palate. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e521-e525. [PMID: 35272091 DOI: 10.1016/j.jormas.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Velopharyngeal insufficiency persists in 15 to 30% of children with cleft palate, despite early velar surgery. Pharyngoplasty using a superior pedicle flap is the most common secondary surgery to treat velopharyngeal insufficiency. This study aims to identify the criteria leading to indicate velopharyngoplasty in 3 groups of age. MATERIALS AND METHODS we conducted a retrospective single center study in the reference center for cleft palate in Paris from 2013 to 2016. We included 61 children with non-syndromic cleft operated on with a velopharyngoplasty for velopharyngeal insufficiency. Pre-operative speech and surgical assessments, as well as the operative reports of the children, were analyzed retrospectively using multivariate models. RESULTS We included 61 patients. The only criteria factor for an early velopharyngoplasty was the Pittsburgh Weighted Speech Scale (PWSS) score (OR 1.20, CI 95% 1.07 to 1.4 ; P=.006). Criteria for a late velopharyngoplasty were a degradation of the velopharyngeal function (OR 16.07, CI 95% 1.7 to 518.7 ; P=.041) and lost of follow-up (OR 5.78, CI 95% 3.9 to 4320 ; P=.017). CONCLUSION Criteria for early and late velopharyngoplasty were identified, and we demonstrated the insufficiency of Borel-Maisonny classification for scientific clinical study.
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Affiliation(s)
- Estelle Sanquer
- Department of Maxillo-facial and Plastic Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; facial cleft and malformation national network, Paris, France
| | - Quentin Hennocq
- Department of Maxillo-facial and Plastic Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; facial cleft and malformation national network, Paris, France
| | - Arnaud Picard
- Department of Maxillo-facial and Plastic Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; facial cleft and malformation national network, Paris, France; University of Paris, France
| | - Alexandra Bucur-Girard
- Department of Maxillo-facial and Plastic Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; facial cleft and malformation national network, Paris, France
| | - Natacha Kadlub
- Department of Maxillo-facial and Plastic Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; facial cleft and malformation national network, Paris, France; University of Paris, France.
| | - Cécilia Neiva-Vaz
- Department of Maxillo-facial and Plastic Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; facial cleft and malformation national network, Paris, France
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Diallo-Hornez G, Khonsari RH, Mercier JM, Delaire J, Balandier S, Defay V, Isidor B, Rousteau G, Talmant JC, Perrin JP, Bertin H, Corre P. Could pharyngeal fat injection be a first-line treatment of velopharyngeal insufficiency? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e206-e211. [PMID: 34844018 DOI: 10.1016/j.jormas.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Garance Diallo-Hornez
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Roman Hossein Khonsari
- Hôpital Necker Enfants - Malades, Service de Chirurgie Maxillo-faciale et Chirurgie Plastique, Assistance Publique - Hôpitaux de Paris, Université de Paris , Paris, France
| | - Jacques-Marie Mercier
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean Delaire
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Sophie Balandier
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Virginie Defay
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Bertrand Isidor
- Service de Génétique clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Gabriel Rousteau
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean-Claude Talmant
- Chirurgie Plastique, Reconstructrice et Esthétique, Clinique Jules Verne, Nantes, France
| | - Jean-Philippe Perrin
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Hélios Bertin
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pierre Corre
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France.
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Hypoxia Regulation of Phosphokinases and the Prognostic Value of pAKT in Breast Cancer. Int J Biol Markers 2018; 28:151-60. [DOI: 10.5301/jbm.5000008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 11/20/2022]
Abstract
Tumor hypoxia results in poor treatment response and is an indicator of poor outcome in cancer patients. TRIB3 is a hypoxia-upregulated protein involved in the ability of breast cancer cells to survive in hypoxic conditions. It is also involved in the prognosis of cancer patients, possibly by affecting several kinase-signaling pathways. We set out to establish which kinase-signaling pathways are regulated by hypoxia and whether these kinases are relevant for breast cancer prognosis. Using a phosphokinase antibody array comparing cells cultured under hypoxic conditions with those cultured during normoxia, we found that the phosphorylation status of ERK1/2, AKT, p70 S6 kinase, Lck and STAT3 was altered in both MCF7 and MDA-MB-231 breast cancer cells. Using Western blotting, we found that phosphorylated AKT (pAKT) increased in hypoxic conditions. Knockdown of TRIB3 attenuated this effect of hypoxia on AKT activation. Both pAKT and TRIB3 were expressed in pimonidazole-positive, hypoxic areas of human breast cancer tumors. In breast cancer patients significantly lower 5-year disease-free survival was observed for the pAKT-positive compared to the pAKT-negative group (64.6% vs 86.1%, p=0.03). In conclusion, the phosphorylation status of AKT is increased in hypoxic conditions and TRIB3 knockdown attenuates this response. Furthermore, pAKT expression denotes a worse prognosis in breast cancer patients. The hypoxia-related activation of AKT could explain the resistance to various treatments including chemotherapy and radiotherapy.
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Talmant JC, Talmant JC, Lumineau JP. [Secondary treatment of cleft lip and palate]. ANN CHIR PLAST ESTH 2016; 61:360-370. [PMID: 27553116 DOI: 10.1016/j.anplas.2016.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
For 18 years our protocol has corrected the cleft lip nose and achieved an intravelar veloplasty at the time of the first operation, leaving the least scaring as possible. No doubt that the best treatment of the sequellae is their prevention: - the oro-nasal fistulas have disappeared; the nostril is almost normal; the continuity of a wide maxillary arch is restored in primary dentition - all that favor a nasal ventilation. This context has changed the nature of the secondary treatment described here. When lip and nose are not good enough we must address the residual deformities with the primary surgery principles. The velopharyngeal insufficiency calls for a velar re-repair and the pharyngeal depth is to be reduced by lipofilling. The rare cases of failure are improved by an Orticochea sphincteroplasty.
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Affiliation(s)
- J C Talmant
- Centre de compétence de traitement des fentes labio-palatines des Pays-de-Loire, clinique Jules-Verne, 2, route de Paris, 44300 Nantes, France.
| | - J C Talmant
- Centre de compétence de traitement des fentes labio-palatines des Pays-de-Loire, clinique Jules-Verne, 2, route de Paris, 44300 Nantes, France.
| | - J P Lumineau
- Centre de compétence de traitement des fentes labio-palatines des Pays-de-Loire, clinique Jules-Verne, 2, route de Paris, 44300 Nantes, France
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James I. [Surgical care of cleft lip and palate: anatomic types, surgical technics and schedules displayed by the different french "cleft centers"]. Arch Pediatr 2010; 17:781-2. [PMID: 20654890 DOI: 10.1016/s0929-693x(10)70108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- I James
- Clinique du Val-d'Ouest, 69130 Ecully, France.
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Trichet-Zbinden C, de Buys Roessingh A, Herzog G, Martinez H, Oger P, Delerive-Taieb MF, Soupre V, Picard A, Vazquez MP, Galliani E, Hohlfeld J. Fentes labio-palatines : guidance orthophonique au sein de l’équipe pluridisciplinaire. Arch Pediatr 2010; 17:790-1. [DOI: 10.1016/s0929-693x(10)70113-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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