A Treatment Protocol for Velopharyngeal Insufficiency and the Outcome

Yamaguchi, Kazushige; Lonic, Daniel; Lee, Che-Hsiung; Wang, Shuhui; Yun, Claudia; Lo, Lun-Jou

doi:10.1097/prs.0000000000002386

Cited by 65 publications

(40 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Another key finding of this study was that indications for selecting re-repair to treat VPI vary among surgeons. The most commonly cited indications for selecting re-repair were anterior, sagittal, or nontransverse position of the palatal muscles on clinical examination (n = 6, 33%) (Chen et al, 1994; Sommerlad et al, 1994; Wojcicki & Wojcicka, 2008; Mehendale et al, 2013; Elsherbiny et al, 2018), and small velopharyngeal (VP) gap on nasopharyngoscopy (n = 4, 22%) (Chen et al, 1994; Madrid et al, 2011; Barbosa et al, 2013; Yamaguchi et al, 2016). In contrast to this targeted application of re-repair, 2 studies used re-repair as their treatment for all children with VPI after CP repair (Deren et al, 2005; Woo et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…Both operations are highly effective; a recent meta-analysis determined overall effectiveness for achieving normal resonance was 76% for pharyngeal flap and 61% for sphincter pharyngoplasty (de Blacam et al, 2018). However, both operations are associated with a substantial risk of obstructive sleep apnea (OSA), estimated at 19% to 93% (Orr et al, 1987; Wells et al, 1999; Liao et al, 2004; Abyholm et al, 2005; Yamaguchi et al, 2016). Thus, while pharyngeal flap and sphincter pharyngoplasty are highly effective in treating VPI, they can also produce substantial morbidity through OSA.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Effectiveness of Palate Re-Repair for Treating Velopharyngeal Insufficiency: A Systematic Review and Meta-Analysis

Kurnik

Weidler

Lien

et al. 2020

The Cleft Palate Craniofacial Journal

View full text Add to dashboard Cite

Background: Palate re-repair has been proposed as an effective treatment for velopharyngeal insufficiency (VPI) with a low risk of obstructive sleep apnea (OSA). The authors conducted a systematic review and meta-analysis to determine the proportion of patients achieving normal speech resonance following palate re-repair for VPI, the proportion developing OSA, and the criteria for patient selection that are associated with increased effectiveness. Methods: PubMed, Embase, and Scopus were searched from inception through April 2018 for English language articles evaluating palate re-repair for the treatment of VPI in patients with a repaired cleft palate. Inclusion criteria included reporting of hypernasality, nasal air emission, nasometry, additional VPI surgery, and/or OSA outcomes. Meta-analysis was conducted using random effects models. Risk of bias was assessed regarding criteria for patient selection, blinding of outcome assessors, and validity of speech assessment scale. Results: Eighteen studies met inclusion criteria. The incidence of achieving no consistent hypernasality follow palate re-repair was 61% (95% confidence interval [CI]: 44%-75%). The incidence of additional surgery for persistent VPI symptoms was 21% (95% CI: 12%-33%). The incidence of OSA was 28% (95% CI: 13%-49%). Criteria for selecting patients to undergo re-repair varied, with anterior/sagittal position of palatal muscles (33%) and small velopharyngeal gap (22%) being the most common. No specific patient selection criteria led to superior speech outcomes ( P = .6572). Conclusions: Palate re-repair achieves normal speech resonance in many but not all patients with VPI. Further research is needed to identify the specific examination and imaging findings that predict successful correction of VPI with re-repair.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Palate Re-Repair for Treating Velopharyngeal Insufficiency: A Systematic Review and Meta-Analysis

Kurnik

Weidler

Lien

et al. 2020

The Cleft Palate Craniofacial Journal

View full text Add to dashboard Cite

show abstract

“…A retrospective chart review was conducted for 84 consecutive nonsyndromicpostpalatoplasty patients undergoing velopharyngeal insufficiency pharyngeal flap group showed postoperative snoring, and one (2.6 per cent) of them presented with obstructive sleep apnea. 18 Snoring was because of narrowing of the effective velopharyngeal orifice and halitosis because of pooled up oral secretion over the flap. None of the patients had symptoms of obstructive sleep apnoea.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and Management of Velopharyngeal Incompetence

Srinath¹,

Kishore²,

Reddy³

et al. 2019

IJCMSR

View full text Add to dashboard Cite

Palatoplasty for cleft lip and palate is associated with two major complications speech development disorders, including velopharyngeal insufficiency, and maxillary growth disturbance. Current study aimed to assess velopharyngeal incompetence and anatomical factors contributing to incomplete closure following cleft palate repair and to evaluated the patients after the surgical procedure and attempted to recommend an appropriate management strategy. Materials and Methods: A prospective observational study was conducted from January 2011 to January-2013. A total of 28 patients with operated cleft palate having clinical features of velopharyngeal insufficiency were included in the study. Patients were evaluated by history, physical examination, Video fluoroscopy, Nasoendoscopy. Velopharyngeal gap size and closure pattern were taken into account based on the endoscopy report. Velopharyngeal gap size was rated on a four-point scale. Results: Among our study participants, 9 (32%) were aged between 11 to 15 years, and 16 (57%) were males. Out of 28 cases with velopharyngeal incompetence, who were assessed endoscopically, the distribution of closure pattern was circular in 20(72%) cases. There were no patients found with sagittal closure pattern. Conclusion: Our study concluded that Surgical correction of VPI improves speech and patients are advised speech therapy to improve the compensatory articulations.

show abstract

“…Successful correction of VPD in patients with 22q11.2DS and severe VPD thus typically necessitates an aggressive surgical approach. Various surgical techniques have been advocated, including wide posterior pharyngeal flap (PPF), Hynes pharyngoplasty, and sphincter pharyngoplasty (Ysunza et al, 2002; Perkins et al, 2005; Swanson et al, 2011; Sprujit et al, 2012a; Yamaguchi et al, 2016). These procedures, however, are not without risks as any rearrangement of the upper airway anatomy can alter airflow dynamics.…”

Section: Introductionmentioning

confidence: 99%

Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

Lee

Chang

Solot

et al. 2020

The Cleft Palate Craniofacial Journal

View full text Add to dashboard Cite

Objective: To determine pre- and postoperative prevalence of obstructive sleep apnea (OSA) in patients with 22q11.2 deletion syndrome (DS) undergoing wide posterior pharyngeal flap (PPF) surgery for velopharyngeal dysfunction (VPD). Design: Retrospective study using pre- and postoperative polysomnography (PSG) to determine prevalence of OSA. Medical records were reviewed for patients’ medical comorbidities. Parents were surveyed about snoring. Setting: Academic tertiary care pediatric hospital. Patients: Forty patients with laboratory confirmed 22q11.2DS followed over a 6-year period. Interventions: Pre- and postoperative PSG, speech evaluation, and parent surveys. Main Outcome Measure: Severity and prevalence of OSA, defined by obstructive apnea hypopnea index (OAHI), before and after PPF surgery to determine whether PPF is associated with increased risk of OSA. Results: Mean OAHI did not change significantly after PPF surgery (1.1/h vs 2.1/h, P = .330). Prevalence of clinically significant OSA (OAHI ≥ 5) was identical pre- and postoperatively (2 of 40), with both cases having severe-range OSA requiring positive airway pressure therapy. All other patients had mild-range OSA. Nasal resonance was graded as severe preoperatively in 85% of patients. None were graded as severe postoperatively. No single patient factor or parent-reported concern predicted risk of OSA (OAHI ≥ 1.5). Conclusions: Patients with 22q11.2DS are medically complex and are at increased risk of OSA at baseline. Wide PPF surgery for severe VPD does not significantly increase risk of OSA. Careful perioperative planning is essential to optimize both speech and sleep outcomes.

show abstract

A Treatment Protocol for Velopharyngeal Insufficiency and the Outcome

Abstract: Therapeutic, IV.

Cited by 65 publications

References 25 publications

The Effectiveness of Palate Re-Repair for Treating Velopharyngeal Insufficiency: A Systematic Review and Meta-Analysis

The Effectiveness of Palate Re-Repair for Treating Velopharyngeal Insufficiency: A Systematic Review and Meta-Analysis

Evaluation and Management of Velopharyngeal Incompetence

Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

Contact Info

Product

Resources

About