1
|
Bertucci V, Stevens K, Sidhu N, Suri S, Bressmann T. The Impact of Fan-Type Rapid Palatal Expanders on Speech in Patients With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2022:10556656221084541. [PMID: 35249395 DOI: 10.1177/10556656221084541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rapid palatal expanders (RPEs) are commonly used in patients with cleft lip and palate (CLP) prior to secondary alveolar bone grafting (SABG). Their position and size can impede tongue movement and affect speech. This study assessed changes in perception and production of speech over the course of RPE treatment. Prospective longitudinal. Tertiary university-affiliated hospital. Twenty-five patients with unilateral CLP treated with Fan-type RPEs, and their parents. Patient and parent speech questionnaires and patient speech recordings were collected at baseline before RPE insertion (T1), directly after RPE insertion (T2), during RPE expansion (T3), during RPE retention (T4), directly after RPE removal but before SABG (T5), and at short-term follow-up after RPE removal and SABG (T6). Ratings for patient and parent questionnaires, first (F1) and second (F2) formants for vowels /a/, /i/, and /u/, and nasalance scores for non-nasal and nasal sentences, were obtained and analyzed using mixed model analyses of variance. Ratings worsened at T2. For the vowel /a/, F1 and F2 were unchanged at T2. For the vowel /i/, F1 increased and F2 decreased at T2. For the vowel /u/, F1 was unchanged and F2 decreased at T2. Nasalance was unchanged at T2. All outcome measures returned to T1 levels by T4. RPE insertion resulted in initial adverse effects on speech perception and production, which decreased to baseline prior to removal. Information regarding transient speech dysfunction and distress may help prepare patients for treatment.
Collapse
Affiliation(s)
- Virginia Bertucci
- Department of Orthodontics, 70374Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Kyle Stevens
- Division of Orthodontics, Department of Dentistry, 7979The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole Sidhu
- Division of Orthodontics, Department of Dentistry, 7979The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunjay Suri
- Department of Orthodontics, 70374Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.,Division of Orthodontics, Department of Dentistry, 7979The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tim Bressmann
- Department of Speech-Language Pathology, 12366Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Bénateau H, Garmi R, Chatellier A, Ambroise B, Maltezeanu A, Veyssière A. [Palato velar fistulae in cleft palate]. ANN CHIR PLAST ESTH 2019; 64:406-412. [PMID: 31178309 DOI: 10.1016/j.anplas.2019.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/19/2022]
Abstract
Palatal fistulas after primary closure of a cleft palate are extremely variable ranging from 15 to 35%. When they are symptomatic, these fistulas affect feeding (nasal regurgitation to liquids, discharge, bad smells) and phonation (hypernasality that can hinder the precise assessment of velar incompetence). First of all, it is important to analyze the cause of the fistula, it helps to avoid early recurrences. The correction must apply to respect the 2 mucosal planes (nasal mucosa and oral mucosa), the only guarantee of surgical success. Different techniques are usually described: lingual flap, lifting of all palatal mucosa, flap hinge, blaster, FAMM. In all cases, postoperative care plays a key role in the success of the surgical correction.
Collapse
Affiliation(s)
- H Bénateau
- Service de chirurgie maxillo-faciale, CHU de Côte de Nacre, 14000 Caen, France; Faculté de médecine, université de Caen Basse Normandie, 14032 Caen cedex 5, France; EA7451 équipe BioConnecT, UNICAEN, avenue de la Côte de Nacre, 14000 Caen, France
| | - R Garmi
- Service de chirurgie maxillo-faciale, CHU de Côte de Nacre, 14000 Caen, France
| | - A Chatellier
- Service de chirurgie maxillo-faciale, CHU de Côte de Nacre, 14000 Caen, France
| | - B Ambroise
- Service de chirurgie maxillo-faciale, CHU de Côte de Nacre, 14000 Caen, France
| | - A Maltezeanu
- Service de chirurgie maxillo-faciale, CHU de Côte de Nacre, 14000 Caen, France; Faculté de médecine, université de Caen Basse Normandie, 14032 Caen cedex 5, France
| | - A Veyssière
- Service de chirurgie maxillo-faciale, CHU de Côte de Nacre, 14000 Caen, France; Faculté de médecine, université de Caen Basse Normandie, 14032 Caen cedex 5, France; EA7451 équipe BioConnecT, UNICAEN, avenue de la Côte de Nacre, 14000 Caen, France.
| |
Collapse
|
3
|
Roode G, Bütow KW, Naidoo S. Preoperative evaluation of micro-organisms in non-operated cleft in soft palate: impact on use of antibiotics. Br J Oral Maxillofac Surg 2017; 55:127-131. [DOI: 10.1016/j.bjoms.2016.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/20/2016] [Indexed: 11/27/2022]
|
4
|
Comparison of the fistula risk associated with rotation palatoplasty and conventional palatoplasty for cleft palate repair. J Craniofac Surg 2015; 25:1728-33. [PMID: 25162544 DOI: 10.1097/scs.0000000000000967] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The aims of the cleft palate repair techniques are to reduce the velopharyngeal insufficiency risk and oronasal fistula development to minimal levels without affecting the maxillofacial development. In this article, we present a retrospective study comparing the conventional palatoplasty techniques with the new technique of rotation palatoplasty for the risk of development of oronasal fistula. MATERIALS AND METHODS Of the 100 patients who were operated on because of cleft palate between the years 2002 and 2008, 12 patients had Furlow palatoplasty, and 88 patients received the Veau-Wardill-Kilner (V-Y pushback) operation (group C). A total of 67 patients who were operated on between 2008 and 2011 had rotation palatoplasty (group R). RESULTS One hundred patients were men, and 67 were women. Among all the patient groups, 22.8% were classified as Veau 1, 24.6% were classified as Veau 2, 37.1% were classified as Veau 3, and 15.6% were classified as Veau 4. The rate of fistula was found to be 17.7% in all patients. Fistula development was found in 6% of the patients in group R (4/67) and in 18% of the patients in group C (18/100). The difference between group R and group C regarding the number of patients who developed fistula was statistically significant (P = 0.011). CONCLUSIONS The Veau classification of the cleft palate affects the risk of fistula development, and the risk for fistula after rotation palatoplasty is lower than that associated with the V-Y pushback technique.
Collapse
|
5
|
Inferior Turbinate Flap for Nasal-side Closure of Palatal Fistula in Cleft Patients: Technical Note. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 2:e265. [PMID: 25587499 PMCID: PMC4292247 DOI: 10.1097/gox.0000000000000239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 10/22/2014] [Indexed: 11/26/2022]
Abstract
Summary: Residual palatal fistula after repair of palatal cleft is common. Repair of residual oronasal fistula is not always successful. Two-layer closure techniques that close these fistulas with soft tissue are a common practice. Turnover flaps are the most used flaps and often the sole method for nasal-side closure of fistula. Anteriorly based inferior turbinate flap can be used to provide soft tissue for nasal-side closure when turnover flaps will not provide sufficient tissue for this purpose. Under general anesthesia with nasotracheal intubation, inferior turbinate was released from posterior attachment. After removing the inferior conchal bone, mucoperiosteal flap was used for nasal-side closure of anterior palatal fistula in patients with cleft. Anteriorly based inferior turbinate flap was used for nasal-side closure of residual palatal fistula in 3 patients with cleft. Age of the patients was 14, 16, and 18, and recurrence of palatal fistula has not occurred. Anteriorly based inferior turbinate flap is an axial pattern flap with appropriate surface of the paddle and vicinity to the oral cavity roof. It can be used in large anterior, palatal fistula for reconstruction of nasal floor. Considering appropriate another flap for oral side coverage of such fistula is mandatory.
Collapse
|
6
|
Woisard V, Noirrit-Esclassan E, Vandrebeck V, Al Hawat A, Galinier P, Lauwers F. Impact of obturation of palatal fistulae on speech quality and aerodynamic parameters in patients with cleft palates. Folia Phoniatr Logop 2013; 65:171-7. [PMID: 24356258 DOI: 10.1159/000355133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this prospective study was to measure nasal and oral airflow during speech, before and after obturation. PATIENTS AND METHODS Included were children aged 3-18 years with nonsyndromic clefts and palatal fistulae. The corpus used was: syllable /pi/; a sentence containing stop consonants and a nasal phoneme; and the description of a picture of a scene. Analysis criteria were: percentage of nasality; value of average flow for the explosion; perceived nasality and intelligibility; and tolerance of the proposed device. RESULTS Only 5 children were included due to the observation of an increase in the percentage of nasality after obturation. The value of average flow for the explosion increased in all patients. A decrease in perceived nasality was noted in all but 1 patient. An improvement in intelligibility was observed in 3 out of the 5 children. The tolerance of the device was good. CONCLUSION While the small number of patients studied does not permit firm conclusions concerning the efficiency of the obturation, the method described, as well as the introduction of 'speed of explosion' of stop consonants, offer new perspectives to prospectively study obturator effects on speech.
Collapse
Affiliation(s)
- Virginie Woisard
- Voice and Deglutition Unit, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Rangueil-Larrey, Toulouse, France
| | | | | | | | | | | |
Collapse
|
7
|
Offert B, Pazera P, Janiszewska-Olszowska J, Hozyasz K, Katsaros C, Fudalej PS. Dental arch relationship in 5-year-olds with complete unilateral cleft lip and palate after early alveolar bone grafting. Orthod Craniofac Res 2012; 15:117-23. [DOI: 10.1111/j.1601-6343.2012.01544.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
8
|
Repair of cleft palate by rotation–transposition of the two mucoperiosteal flaps: can this reduce the incidence of postoperative fistula? EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0517-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Abdel-Aziz M, Ghandour H. Comparative study between V-Y pushback technique and Furlow technique in cleft soft palate repair. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: doi 10.1007/s00238-010-0443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
10
|
Comparative study between V-Y pushback technique and Furlow technique in cleft soft palate repair. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0443-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Bekerecioglu M, Isik D, Bulut O. Comparison of the rate of palatal fistulation after two-flap and four-flap palatoplasty. ACTA ACUST UNITED AC 2009; 39:287-9. [PMID: 16320405 DOI: 10.1080/02844310510006529] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We studied 73 repairs of cleft palate (48 cleft lip and palate and 25 isolated cleft palate) done during a 7-year period (January 1996-October 2002) by the same plastic reconstructive surgeon. Two-flap or four-flap palatoplasty techniques were used to provide tension-free, three-layer repairs for patients with cleft palate. Their ages ranged from 10-244 months (mean 27). The postoperative follow-up period ranged from 6 to 60 months (mean 21). There was a palatal fistulation rate of 7% (5/73). There were two fistulas after two-flap palatoplasty (5%, 2/39), and three fistulas after four-flap palatoplasty (9%, 3/34). The mean diameter was 7.8 mm (range 5.1 to 13). There was no significant difference between the two techniques.
Collapse
Affiliation(s)
- Mehmet Bekerecioglu
- Department of Plastic Surgery, Gaziantep University, Faculty of Medicine, Gaziantep, Turkey.
| | | | | |
Collapse
|
12
|
Stewart TL, Fisher DM, Olson JL. Modified Von Langenbeck cleft palate repair using an anterior triangular flap: decreased incidence of anterior oronasal fistulas. Cleft Palate Craniofac J 2008; 46:299-304. [PMID: 19642748 DOI: 10.1597/07-185.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE A complication following cleft palate surgery is the development of oronasal fistulas. Despite recent advances aimed at addressing this concern, rates of postoperative fistulas have remained unchanged and are reported at between 3% and 60%. Oronasal fistulas commonly occur between the hard and soft palate and at the anterior portion of the cleft. These fistulas lead to functional problems with nasal emission, hypernasal speech, and food regurgitation through the nose. For clefts of the secondary palate, we developed a modification of the Von Langenbeck technique in which an anterior triangular flap is used to decrease the incidence of postoperative fistulas. METHOD A triangular flap composed of oromucosa was designed for isolated clefts of the secondary palate only. It is based at the anterior margin of the cleft and is used as a turnover flap to allow closure of the often very tight anterior nasal side. A retrospective chart analysis was performed from 2000 to 2007. All patients who had isolated clefts of the secondary palate and had undergone a modified Von Langenbeck procedure were included in the study. Patients were evaluated 4 to 8 weeks postoperatively for the presence of oronasal fistulas. RESULTS With the introduction of the anterior triangular flap, we show that 0 of 182 patients developed a postoperative oronasal fistula. CONCLUSIONS This modification of the standard Von Langenbeck uses an anterior triangular flap and confers the advantage of assisting in nasal side closure of the anterior margin of the cleft; in doing so, it reduces the rate of fistula formation.
Collapse
Affiliation(s)
- Tara Lynn Stewart
- Division of Pediatric and Plastic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | | |
Collapse
|
13
|
Rennie A, Treharne LJ, Richard B. Throat swabs taken on the operating table prior to cleft palate repair and their relevance to outcome: a prospective study. Cleft Palate Craniofac J 2008; 46:275-9. [PMID: 19642759 DOI: 10.1597/08-082.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The main objective of this study was to determine whether bacteria cultured from oral swabs taken at the time of surgery predicted postoperative fistula formation. DESIGN The study was a prospective longitudinal audit. SETTING The setting was a designated U.K. N.H.S. cleft center. PATIENTS Subjects consisted of the patients of a single cleft surgeon who were undergoing surgery for cleft palate repair or cleft fistula repair. INTERVENTIONS Oral microbiological swabs were taken from patients while they were on the operating table just before surgery. MAIN OUTCOME MEASURES The results from microbiological culture of the swabs were recorded, as was the presence or absence of a fistula at 6 months postoperatively. Additional collected information was related to the severity of the cleft, whether the operating microscope was used during surgery, and whether the patient had developed a postoperative upper respiratory tract infection. RESULTS Positive swab cultures were not significantly associated with fistula formation. Use of the operating microscope was not associated with an increase or decrease in the number of fistulas. A fistula developed in all patients who experienced a postoperative upper respiratory tract infection. CONCLUSIONS The practice of performing routine preoperative mouth swabs should be abandoned because the presence of bacteria in the mouth does not increase the risk of fistula formation.
Collapse
|
14
|
Smith DM, Vecchione L, Jiang S, Ford M, Deleyiannis FWB, Haralam MA, Naran S, Worrall CI, Dudas JR, Afifi AM, Marazita ML, Losee JE. The Pittsburgh Fistula Classification System: a standardized scheme for the description of palatal fistulas. Cleft Palate Craniofac J 2008; 44:590-4. [PMID: 18177198 DOI: 10.1597/06-204.1] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Vague terminology is a problem in cleft palate research. No classification scheme for palatal fistulas has been proposed to date. Although a well-healed velum is a significant outcome of palatoplasty, it is nearly impossible to compare fistula-related palatoplasty results in the literature or in medical records without a standardized vocabulary. We endeavor to devise a palatal fistula classification system that may have clinical and research applicability. DESIGN PubMed was searched for definitions and classifications of palatal fistula as well as incidence and recurrence rates of this outcome. Next, a 25-year retrospective review of our Cleft Center's records was performed, and fistulas were identified (n=641 charts reviewed). The fistula descriptions yielded by this chart review were evaluated in the context of anatomical descriptions in the literature, and a clinician-friendly classification scheme was designed. RESULTS A literature review failed to reveal a standardized fistula classification system. An anatomically based numerical fistula classification system was devised: type I, bifid uvula; type II, soft palate; type III, junction of the soft and hard palate; type IV, hard palate; type V, junction of the primary and secondary palates (for Veau IV clefts); type VI, lingual alveolar; and type VII, labial alveolar. CONCLUSIONS We propose a standardized numerical classification system for palatal fistulas. Its clinical adoption may prospectively clarify ambiguities in the literature and facilitate future cleft palate research and clinical practice.
Collapse
Affiliation(s)
- Darren M Smith
- Children's Hospital of Pittsburgh, Division of Pediatric Plastic Surgery, and Center for Craniofacial and Dental Genetics, Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, PA 15213, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Fukuda M, Lino M, Takahashi T. Closure of large oronasal fistulas at the time of secondary bone grafting in patients with cleft lip and palate. ACTA ACUST UNITED AC 2005; 37:339-43. [PMID: 15328772 DOI: 10.1080/02844310310004424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Oronasal fistulas often arise after repair of the palate in patients with cleft lip and palate. Those located adjacent to the residual cleft are commonly closed at the time of secondary bone grafting. However, it is not easy to close larger fistulas. We present a method of closing large oronasal fistulas in the anterior palate that are adjacent to the residual cleft at the time of secondary bone grafting, which consists of reducing the size of the inferior nasal turbinate.
Collapse
Affiliation(s)
- Masayuki Fukuda
- Division of Dentistry and Oral Surgery, Akita University School of Medicine, Akita, Japan.
| | | | | |
Collapse
|
16
|
Karling J, Larson O, Henningsson G. Oronasal fistulas in cleft palate patients and their influence on speech. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1993; 27:193-201. [PMID: 8272770 DOI: 10.3109/02844319309078111] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The size, site, and influence on speech of oronasal fistulas were studied in 12 patients with unilateral and 32 with bilateral cleft lip and palate. There were more and larger fistulas in the bilateral group. The series was divided into: those with fistulas that affected speech (group A, n = 18) and those with fistulas that did not affect their speech (group B, n = 26). Group A had significantly larger fistulas than group B, but there were no differences in the sites of the fistulas, either between the bilateral and unilateral groups or between groups A and B. Most fistulas were located in the region of the incisive foramen or in the hard palate. Judgements by listeners and analyses by the NORAM instrument were made of the speech of 12 of the patients in group A before and after temporary covering of the fistulas. Significant differences in hypernasality, according to both listener's judgments and instrumental analyses were found. This finding is further evidence that an oronasal fistula can influence and contribute to velopharyngeal dysfunction.
Collapse
Affiliation(s)
- J Karling
- Department of Logopedics and Phoniatrics, Karolinska Hospital, Stockholm, Sweden
| | | | | |
Collapse
|