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Davis MJ, Roy MG, Burns HR, Yim N, Wilson KD, Moore EE, Buchanan EP, Monson LA. Velopharyngeal Insufficiency Following Furlow Versus Straight Line Repair With Intravelar Veloplasty: A Single-institution Experience. J Craniofac Surg 2023:00001665-990000000-01226. [PMID: 37982999 DOI: 10.1097/scs.0000000000009874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/09/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Measurements of postoperative velopharyngeal dysfunction (VPD) can be used to determine the efficacy of a palatoplasty operation. Hypernasality and audible nasal air emission are typical manifestations of VPD during speech. We aimed to longitudinally compare VPD outcomes in postpalatoplasty patients who underwent Furlow repair versus straight line repair with intravelar veloplasty (IVVP). Additionally, we examined the relationship between VPD outcomes and select pre-existing patient characteristics. METHODS Retrospective chart review was performed to identify primary palatoplasty patients treated from April 2012 to March 2021. Variables collected included gender, syndromic status, primary language, Veau cleft type, type of speech assessment, age at time of surgery, degree of hypernasality, presence of audible nasal air emission, and overall adequacy of velopharyngeal function. Pearson χ2 test and multivariable t tests were used to analyze variables. Logistic regression was used to control for statistically significant variables. RESULTS Of the 118 patients included, 38 received a Furlow procedure and 80 received a straight line with IVVP procedure. Audible nasal air emission was present in 57.3% of straight line with IVVP patients and 42.9% of Furlow patients, with no statistically significant difference between groups. Clinically significant hypernasality was present in 42.1% of straight line with IVVP patients and 22.9% of Furlow patients (P=0.05). Velopharyngeal function was classified as adequate in 63.5% of straight line with IVVP patients and 83.3% of Furlow patients (P=0.03). However, after stratifying by syndromic versus nonsyndromic status, there was no statistically significant difference between straight line with IVVP and Furlow patients for postoperative hypernasality and velopharyngeal function. CONCLUSIONS This study suggests that there are no statistically significant differences between straight line with IVVP and Furlow palatoplasty techniques regarding speech outcomes including hypernasality, audible nasal air emission, and overall VP function. Furthermore, select patient characteristics such as gender, primary language, syndromic status, age at repair, and Veau cleft type do not significantly impact postoperative speech outcomes.
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Affiliation(s)
- Matthew J Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital
| | - Michelle G Roy
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital
| | - Heather R Burns
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital
| | - Nicholas Yim
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Kristina D Wilson
- Speech, Language, and Learning, Texas Children's Hospital, Houston, TX
| | - Ellen E Moore
- Speech, Language, and Learning, Texas Children's Hospital, Houston, TX
| | - Edward P Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital
| | - Laura A Monson
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital
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Ozawa TO, Dutka JDCR, Garib D, Lauris RCMC, Almeida AM, Brosco TVDS, Lauris JRP, Dolce C, Pegoraro-Krook MI. Influence of surgical technique and timing of primary repair on interarch relationship in UCLP: A randomized clinical trial. Orthod Craniofac Res 2020; 24:288-295. [PMID: 33098171 DOI: 10.1111/ocr.12435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/17/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare dental arch relationships in children with unilateral cleft lip and palate (UCLP) between two surgical techniques for repair of cleft lip/palate and two ages of palate repair. SETTINGS AND SAMPLE Dental models were taken for a group of 448 subjects at a mean age of 7 years and were evaluated by means of the Goslon Yardstick. The patients studied consisted of an initial group of 673 infants with complete UCLP randomized into 8 study groups according to lip repair procedures (Millard versus Spina techniques); palate repair procedures (von Langenbeck versus Furlow techniques); and palate repair timing (early: 9 to 12 months versus late: 15-18 months). METHODS Four surgeons performed all surgeries. Dependent variables included the following: lip repair technique, palate repair technique, age at time of palate repair and surgeon; with sex as an independent variable. The data were analysed using a general linear model (P < .05). RESULTS There were no significant differences for occlusal index scores as a function of lip or palate surgical technique, palatal repair timing and sex. Significant differences were found for occlusal index scores as a function of the surgeon. CONCLUSION Dental arch relationships were not influenced by lip and palatal repair techniques or patient age at palatal repair. The surgeon was the major factor that influenced the dental arch relationship outcome.
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Affiliation(s)
- Terumi Okada Ozawa
- Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Jeniffer de Cassia Rillo Dutka
- Department of Speech-Language and Audiology, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Daniela Garib
- Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.,Department of Orthodontics, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Rita C M C Lauris
- Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Araci Malagodi Almeida
- Department of Orthodontics, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Telma Vidotto de Sousa Brosco
- Department of Plastic Surgery, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - José Roberto P Lauris
- Department of Orthodontics, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.,Department of Public Health, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | - Calogero Dolce
- University of Florida College of Dentistry, Gainesville, FL, USA
| | - Maria Inês Pegoraro-Krook
- Department of Speech-Language and Audiology, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
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A comparative study of three palatoplasty techniques in wide cleft palates. Int J Oral Maxillofac Surg 2020; 50:191-197. [PMID: 32758385 DOI: 10.1016/j.ijom.2020.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/14/2020] [Accepted: 07/14/2020] [Indexed: 11/20/2022]
Abstract
The aim of this study was to clinically evaluate the effectiveness of various palatoplasty techniques for the repair of cleft palates greater than 8mm in width. This prospective cohort study included 142 patients with complete cleft palate between September 2017 and January 2019. Among the patients, 60 underwent a modified palatoplasty with Furlow Z-plasty (MPFZP), 51 underwent a von Langenbeck (VL) repair, and 31 underwent a two-flap palatoplasty (2FP). The MPFZP technique was modified with bilateral relaxing incisions and a radical intravelar veloplasty. Descriptive statistics and the χ2 test were used to explore and compare the rates of complications among the three surgical techniques. No statistically significant difference in sex, age at repair, cleft width, or cleft Veau type was found among the three groups. Rates of wound dehiscence at 1 week and fistula formation at 3 months after the surgery also did not differ significantly among the three techniques. However, velopharyngeal function for speech was better in patients who underwent MPFZP compared to the other two techniques (P<0.05). The repair of a wide cleft palate can be difficult due to the tension at closure. Although the study findings did not demonstrate a difference in complication rates among the three techniques, MPFZP appears to have the best functional outcomes in patients with a cleft palate wider than 8mm.
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Téblick S, Ruymaekers M, Van de Casteele E, Nadjmi N. Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review. J Oral Maxillofac Surg 2019; 77:405.e1-405.e15. [DOI: 10.1016/j.joms.2018.09.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 12/01/2022]
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A Systematic Review Comparing Furlow Double-Opposing Z-Plasty and Straight-Line Intravelar Veloplasty Methods of Cleft Palate Repair. Plast Reconstr Surg 2014; 134:1014-1022. [DOI: 10.1097/prs.0000000000000637] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prospective Clinical Trial Comparing Outcome Measures Between Furlow and von Langenbeck Palatoplasties for UCLP. Ann Plast Surg 2011; 66:154-63. [DOI: 10.1097/sap.0b013e3181d60763] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Campbell A, Costello BJ, Ruiz RL. Cleft lip and palate surgery: an update of clinical outcomes for primary repair. Oral Maxillofac Surg Clin North Am 2010; 22:43-58. [PMID: 20159477 DOI: 10.1016/j.coms.2009.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The comprehensive management of cleft lip and palate has received significant attention in the surgical literature over the last half century. It is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. In the United States, current estimates place the prevalence of cleft lip and palate or isolated cleft lip at approximately 1 in 600. There is significant phenotypic variation in the specific presentation of facial clefts. Understanding outcome data is important when making clinical decisions for patients with clefts. This article provides an update on current primary cleft lip and palate outcome data.
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Affiliation(s)
- Andrew Campbell
- Division of Craniofacial and Cleft Surgery, Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, 3471 Fifth Avenue, Suite 1112, Pittsburgh, PA 15213, USA
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Lohmander A, Willadsen E, Persson C, Henningsson G, Bowden M, Hutters B. Methodology for speech assessment in the Scandcleft project--an international randomized clinical trial on palatal surgery: experiences from a pilot study. Cleft Palate Craniofac J 2009; 46:347-62. [PMID: 19642772 DOI: 10.1597/08-039.1] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To present the methodology for speech assessment in the Scandcleft project and discuss issues from a pilot study. DESIGN Description of methodology and blinded test for speech assessment. Speech samples and instructions for data collection and analysis for comparisons of speech outcomes across five included languages were developed and tested. PARTICIPANTS AND MATERIALS: Randomly selected video recordings of 10 5-year-old children from each language (n = 50) were included in the project. Speech material consisted of test consonants in single words, connected speech, and syllable chains with nasal consonants. Five experienced speech and language pathologists participated as observers. MAIN OUTCOME MEASURES Narrow phonetic transcription of test consonants translated into cleft speech characteristics, ordinal scale rating of resonance, and perceived velopharyngeal closure (VPC). A velopharyngeal composite score (VPC-sum) was extrapolated from raw data. Intra-agreement comparisons were performed. RESULTS Range for intra-agreement for consonant analysis was 53% to 89%, for hypernasality on high vowels in single words the range was 20% to 80%, and the agreement between the VPC-sum and the overall rating of VPC was 78%. CONCLUSIONS Pooling data of speakers of different languages in the same trial and comparing speech outcome across trials seems possible if the assessment of speech concerns consonants and is confined to speech units that are phonetically similar across languages. Agreed conventions and rules are important. A composite variable for perceptual assessment of velopharyngeal function during speech seems usable; whereas, the method for hypernasality evaluation requires further testing.
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Affiliation(s)
- A Lohmander
- Division of Speech and Language Pathology, Sahlgrenska Academy at University of Gothenburg, PO Box 452, SE 405 30, Gothenburg, Sweden.
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Sie KC, Tampakopoulou DA, Sorom J, Gruss JS, Eblen LE. Results with Furlow palatoplasty in management of velopharyngeal insufficiency. Plast Reconstr Surg 2001; 108:17-25; discussion 26-9. [PMID: 11420500 DOI: 10.1097/00006534-200107000-00004] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A retrospective study was undertaken to assess speech outcomes in patients undergoing Furlow palatoplasty. Since 1994, the authors have used the position of the levator veli palatini musculature to determine type of surgical intervention recommended for the management of velopharyngeal insufficiency. Furlow palatoplasty has been used in patients with clinical evidence of sagittally oriented levator veli palatini musculature. Forty-eight patients who underwent a Furlow palatoplasty between June of 1994 and August of 1998 were included. All patients underwent preoperative and postoperative perceptual speech analyses to describe velopharyngeal insufficiency severity, nasal air emissions, and resonance, and preoperative nasendoscopy to assess velopharyngeal gap size and palatal and lateral pharyngeal wall movement. Other patient characteristics considered included gender, age at time of surgery, previously repaired cleft palate, submucous cleft palate, and syndrome diagnosis. Speech outcomes were determined on the basis of postoperative perceptual speech analyses and were categorized in one of three ways: (1) complete resolution of velopharyngeal insufficiency, (2) substantial improvement of velopharyngeal insufficiency, and (3) audible residual velopharyngeal insufficiency. Complete resolution of velopharyngeal insufficiency was defined as normal resonance and an absence of nasal air emissions. Substantial improvement of velopharyngeal insufficiency was defined as an improvement of at least two categories in velopharyngeal insufficiency severity in those patients without complete resolution. Audible residual velopharyngeal insufficiency refers to patients with postoperative velopharyngeal insufficiency severity ratings of mild, moderate, or severe. The male:female ratio in the study was 27:21. Twelve patients were syndromic; three had velocardiofacial syndrome. The median age at surgery was 6.5 years (range, 2 to 22 years). The average duration of follow-up was 14.7 months (range, 1.3 to 58.6 months). Postoperatively, the severity of velopharyngeal insufficiency was rated as none in 19 of the 48 patients (39.6 percent), minimal in eight (16.7 percent), mild in six (12.5 percent), moderate in nine (18.75 percent), and severe in six (12.5 percent). Substantial improvement was seen in seven of the 29 patients without complete resolution. There was a significant association between male gender and complete resolution of velopharyngeal insufficiency (p < 0.05). Presence of syndrome and female gender was associated with audible residual velopharyngeal insufficiency (p < 0.05). The main complication was palatal fistula (two cases). In conclusion, most patients who underwent a Furlow palatoplasty had a complete resolution or substantial improvement of velopharyngeal insufficiency postoperatively, and there were few surgical complications.
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Affiliation(s)
- K C Sie
- Division of Pediatric Otolaryngology, Department of Surgery, University of Washington School of Medicine, Seattle, WA 98105.
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Schönweiler R, Lisson JA, Schönweiler B, Eckardt A, Ptok M, Tränkmann J, Hausamen JE. A retrospective study of hearing, speech and language function in children with clefts following palatoplasty and veloplasty procedures at 18-24 months of age. Int J Pediatr Otorhinolaryngol 1999; 50:205-17. [PMID: 10595666 DOI: 10.1016/s0165-5876(99)00243-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Many cleft palate teams currently schedule palatoplasty and veloplasty within the child's first year of life. At Hannover Medical School, palatoplasty and veloplasty are performed at approximately 18-24 months of age. It was questioned which speech and language outcome was achieved and whether it may be influenced by: (1) type and extent of the clefts; (2) velopharyngeal inadequacy; and (3) hearing disorders. A retrospective evaluation of data collected from 1985 to 1993 was performed summarizing receptive and expressive speech and language skills of 370 children aged 4.5 years. Cleft types were unilateral cleft lip and palate (UCLP, 30.0%), bilateral cleft lip and palate (BCLP, 28.7%), cleft hard and soft palate (CP, 21.6%), cleft soft palate (cleft velum, CV, 10.8%), cleft lip and alveolus (CLA, 5.8%) and submucous clefts (SUB, 3.2%). n = 86 had constant normal hearing, and n = 284 had conductive hearing loss > 20 dB (500-4000 Hz). Severe developmental phonology errors were found in 30-50% of children with repaired cleft palate and in less than 8% of patients with CLA and SUB. Posterior compensatory misarticulation was below 15% in the groups UCLP, BCLP, CP, CV and SUB. Nasal resonance and air emission was nearly normal in CLA, but was increased in 27% to 38% of the other cleft types. Children with conductive hearing loss had significantly more and severely affected phonology, morphology, syntax, vocabulary, language comprehension, and auditory perception than normal hearing children. Findings indicated that speech and language function in CLP patients were predominantly related to the hearing status.
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Affiliation(s)
- R Schönweiler
- Department of Communication Disorders, Treatment Centre for Ophthalmology, Otorhinolaryngology and Communication Disorders, Hannover Medical School, Germany.
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