How Early Can We Predict the Need for VPI Surgery?

Abstract

Background: Velopharyngeal dimensions change as a child with cleft palate (CP) grows. The aim of this study was to assess if the decision for velopharyngeal insufficiency (VPI) surgery can be made by the age of 3 years among CP children with moderate-to-severe VPI. In addition, we sought to clarify if speech therapy before VPI surgery is beneficial for VPI speech characteristics. Methods: This retrospective study reviewed documentation of children with moderate-to-severe VPI at age 3 years who did not undergo VPI surgery until age 5 years. Based on the national cleft register, 959 patients with syndromic and nonsyndromic CP were treated by the craniofacial team at Helsinki University Hospital, Finland between 2000 and 2014. Eighty-six patients fulfilled the study inclusion criteria. The speech pathologist evaluated velopharyngeal function at age 3, 5, and 8 years. Results: Of the 86 children presenting with moderate-to-severe VPI at age 3 years, 94% still had moderate-to-severe VPI at age 5 years, even though speech therapy was offered to 77%. Of those whose velopharyngeal function improved by age 5 years, function regressed to incompetent over time. Overall, 93% underwent VPI surgery and 82% underwent VPI surgery between ages 5 and 8 years. Only 23% at age 8 years still had moderate-to-severe VPI. Speech therapy alone did not improve VPI speech characteristics. Conclusions: Moderate-to-severe VPI did not improve from 3 to 5 years or improved but subsequently relapsed. This suggests that the decision for VPI surgery can be made for children aged 3 years with moderate-to-severe VPI.

The Pediatric Neuroradiologist's Practical Guide to Capture and Evaluate Pre- and Postoperative Velopharyngeal Insufficiency

“…Ninety-three percent of patients with surgical planning for VPI are between 4 and 8 years of age. 19 As a result, most patients scheduled for velopharyngeal MR imaging will typically be between these ages; however, velopharyngeal MR imaging has been demonstrated in VPI surgical planning for patients ranging in age from 3 to 39 years (n ¼ 113 patients) at a single cleft craniofacial center in the United States. 10 Patients are required to be imaged both at rest and while producing and sustaining specific sounds.…”

“…These sounds are commonly used for several reasons. First, most children at the typical age for VPI surgical evaluation (4-8 years of age) 19 are able to produce a sustained /i/ sound without error because this is a basic vowel sound that is acquired early in phonological development. This sound also represents a high back vowel and has been shown to be a sound produced in individuals with normal velopharyngeal anatomy and physiology with the greatest degree of velar closure force.…”