Increased Risk of Velopharyngeal Insufficiency in Patients Undergoing Staged Palate Repair

McCrary, Hilary C.; Pollard, Sarah Hatch; Torrecillas, Vanessa; Khong, Leon; Taylor, Helene M.; Muntz, Harlan R.; Skirko, Jonathan R.

doi:10.1177/1055665620913440

Cited by 11 publications

(5 citation statements)

References 32 publications

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“…Surgeons that prefer performing single-stage repairs cite benefits to this approach including decreased rates of fistula development and velopharyngeal insufficiency (VPI), in addition to decreased surgical, financial, and emotional burden (Stein et al, 2019;McCrary et al, 2020). A recent cost analysis comparing single-stage and staged CP repair demonstrated that a single-stage approach was more cost-efficient than a staged approach (Willadsen, 2012;Holzmer et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Risk of Malocclusion Among Patients Undergoing Single-Stage Versus Two-Stage Cleft Palate Repair

McCrary

Torrecillas

Pollard

et al. 2022

The Cleft Palate Craniofacial Journal

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Objective Evaluate impact of single-stage versus staged palate repair on the risk of developing malocclusion among patients with cleft palate (CP). Design Retrospective cohort study 2000–2016 Setting Academic, tertiary children’s hospital. Patients Patients undergoing CP repair between 1999–2015. Interventions CP repair, categorized as either single-stage or staged. Main Outcome Measure Time to development of Class III malocclusion. Results 967 patients were included; 60.1% had a two-stage CP repair, and 39.9% had single-stage. Malocclusion was diagnosed in 28.2% of patients. In the model examining all patients at ≤5 years ( n = 659), patients who were not white had a higher risk of malocclusion (HR 2.46, p = 0.004) and staged repair was not protective against malocclusion (HR 0.98, p = 0.91). In all patients >5 years ( n = 411), higher Veau classification and more recent year of birth were significantly associated with higher hazard rates ( p < 0.05). Two-staged repair was not protective against developing malocclusion (HR 0.86, p = 0.60). In the model examining patients with staged repair ≤5 years old ( n = 414), higher age at hard palate closure was associated with reduced malocclusion risk (HR 0.67, p < 0.001) and patients who were not white had increased risk (HR 2.56, p = 0.01). In patients with staged repair >5 years old, more recent birth year may be associated with a higher risk of malocclusion (HR 1.06, p = 0.06) while syndrome may be associated with lower risk of malocclusion diagnosis (HR 0.46, p = 0.07). Conclusion Our data suggests that staged CP repair is not protective against developing Class III malocclusion.

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Section: Discussionmentioning

confidence: 99%

Risk of Malocclusion Among Patients Undergoing Single-Stage Versus Two-Stage Cleft Palate Repair

McCrary

Torrecillas

Pollard

et al. 2022

The Cleft Palate Craniofacial Journal

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“…McCrary et al ,[ 28 ] found that the risk of developing a VPI after primary two-stage palate surgery was 1.8 times higher than in one-stage surgery. This study was a large cohort study with a total of 1047 CP patients; 59.6% had a two-stage repair, 40.4% had one-stage CP repair.…”

Section: Discussionmentioning

confidence: 99%

Primary Palatoplasty: A Comparison of Results by Various Techniques - A Retrospective Study

Jargaldavaa

Gongorjav

Badral³

et al. 2022

Annals of Maxillofacial Surgery

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Introduction: To identify a better method for primary cleft palate (CP) repairs with respect to velopharyngeal function. Materials and Methods: A retrospective, longitudinal review of medical charts of patients with congenital CP who underwent four different techniques of palatoplasty, performed by three different surgeons in the Department of Maxillofacial Surgery of the National Center for Maternal and Child Health. Nasopharyngoscopy (NPS) was used for velopharyngeal function evaluation. CP was classified according to the Veau system and the “Golding-Kushner” scale for NPS results was used for assessing the patient’s velopharyngeal function and its association with cleft types and the primary palatoplasty techniques. Pearson’s Chi-square analysis and binary logistic regression were used for statistical analysis. Results: A total of 335 patients were included in the study. The mean age at primary palate repair was 22.9 ± 13.6 months. There were 56, 42, 177, and 60 patients with Veau-I, Veau-II, Veau-III, and Veau-IV types, respectively, whereas for primary palatoplasty 65 patients underwent Furlow, 148 patients – Mongolian, 108 patients – two flap, 34 patients – von Langenbeck technique. NPS assessment of adequate velopharyngeal function was followed by Furlow’s technique in 89.4% of cases, Mongolian technique in 62.2% of cases but by “two flap” only in 48.1% and von Langenbeck in 47.1% of cases. Discussion: The Furlow and Mongolian techniques were superior for maintaining velopharyngeal function after primary palatoplasty.

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“…Clefting of the lip and palate are some of the more common birth anomalies and the most common congenital anomalies of the face (Kummer et al, 2012). Treatment for cleft lip/palate is surgical with the primary goal for these children to obtain normal speech and resonance; however, rates reported for velopharyngeal insufficiency (VPI) have ranged from 10.3% (Mahoney et al, 2013) to 25.6% (McCrary et al, 2020), with rates as high as 32% for 2-staged repairs (McCrary et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Comparing Quality of Life and Perceptual Speech Ratings in Children With Cleft Palate

Pedersen

Goodie

Braden

et al. 2020

The Cleft Palate Craniofacial Journal

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Objective: To delineate the relationship between patient and parent-reported quality of life (QOL) ratings and perceptual characteristics of speech assigned by a speech-language pathologist (SLP) in children with repaired cleft palate. Design: Prospective. Setting: Academic Children’s Hospital. Participants: This population-based sample included children, aged 3 to 18 with a history of repaired cleft palate, and their parents. Intervention: Participants completed the Velopharyngeal Insufficiency Effects on Life Outcomes Questionnaire (VELO). Children’s speech was judged perceptually by an expert SLP using the Pittsburgh Weighted Speech Scale (PWSS). Main Outcome Measure(s): Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire assessed participant and parent perceptions of impact of velopharyngeal function on QOL. Pittsburgh Weighted Speech Scale assessed nasal emissions, facial grimacing, nasality, quality of phonation, and articulation. Results: Enrollment included 48 participant parent dyads. Overall, participants reported high QOL scores within the 95% CI with children reporting slightly better yet not significantly different QOL (86.27 ± 8.96) compared to their parents (81.81 ± 15.2). Children received an average score of 1.38 ± 1.96 on the PWSS corresponding to borderline velopharyngeal competence. A significant moderate negative correlation was found between PWSS total score and parent VELO total score (r = −0.51103, P = .0002). Mild–moderate significant negative correlations were measured between PWSS total and the 5 subscales of the VELO. No significant correlations were measured between PWSS and child VELO total responses or between total scores and subscales. Conclusions: Results suggest that as perceptual analysis of speech improves, overall QOL improves moderately.

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Increased Risk of Velopharyngeal Insufficiency in Patients Undergoing Staged Palate Repair

Cited by 11 publications

References 32 publications

Risk of Malocclusion Among Patients Undergoing Single-Stage Versus Two-Stage Cleft Palate Repair

Risk of Malocclusion Among Patients Undergoing Single-Stage Versus Two-Stage Cleft Palate Repair

Primary Palatoplasty: A Comparison of Results by Various Techniques - A Retrospective Study

Comparing Quality of Life and Perceptual Speech Ratings in Children With Cleft Palate

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