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Speech Outcomes Following Operative Management of Velopharyngeal Dysfunction (VPD) in Non-Syndromic Post-Palatoplasty Cleft Palate Patients.
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- Author(s): Kimia, Rotem; Solot, Cynthia B.; McCormack, Susan M.; Cohen, Marilyn; Blum, Jessica D.; Villavisanis, Dillan F.; Vora, Nisha; Valenzuela, Zachary; Taylor, Jesse A.; Low, David W.; Jackson, Oksana A.
- Source:
Cleft Palate Craniofacial Journal; Jun2024, Vol. 61 Issue 6, p1007-1017, 11p- Subject Terms:
SPEECH evaluation; PHARYNX surgery; PALATE surgery; T-test (Statistics); QUESTIONNAIRES; TERTIARY care; RETROSPECTIVE studies; AGE distribution; DESCRIPTIVE statistics; SEVERITY of illness index; SURGICAL complications; PEDIATRICS; LONGITUDINAL method; SURGICAL flaps; ODDS ratio; OPERATIVE surgery; REOPERATION; CONFIDENCE intervals; VELOPHARYNGEAL insufficiency; CLEFT palate - Source:
- Additional Information
- Abstract: Objective: Approximately 30% of patients with a history of repaired cleft palate (CP) go on to suffer from velopharyngeal dysfunction (VPD). This study discusses the operative management of VPD and postoperative speech outcomes in a cohort of CP patients. Setting: An academic tertiary pediatric care center. Methods: Retrospective cohort study. Patients: Patients with history of repaired CP (Veau I-IV) who underwent operative management of VPD between January 1st, 2010 and December 31st, 2020. Operative modalities were posterior pharyngeal flap (PPF), sphincter pharyngoplasty (SPP), Furlow palate re-repair, and buccal myomucosal flap palate lengthening (PL). Outcome measures: The primary outcome measure is postoperative speech improvement evaluated by the Pittsburgh Weighted Speech Scale (PWSS). Results: 97 patients met inclusion criteria. 38 patients with previous straight-line primary palatoplasty underwent Furlow re-repair; these patients were significantly younger (7.62 vs 11.14, P <.001) and were more likely to have severe VPD per PWSS (OR 4.28, P <.01, 95% CI 1.46-12.56) when compared to VPD patients with previous Furlow repair. 21.1% of these patients required an additional non-revisional VPD procedure. The remaining patients underwent a non-revision procedure (26 PPF, 22 SPP, 11 PL); all experienced significant (P <.001 on paired t-test) reductions in PWSS total and subgroup VPD severity scores without difference in improvement between operation types. SPP was statistically associated with all-cause complication (OR 2.79, 95% CI 1.03-7.59, P <.05) and hyponasality (OR 3.27, 95% CI 1.112-9.630, P <.05). Conclusion: Furlow re-repair reduced need for additional VPD operations. Speech outcomes between non-revisional operations are comparable, but increased complications were seen in SPP. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Cleft Palate Craniofacial Journal is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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