Rates of Revision and Obstructive Sleep Apnea after Surgery for Velopharyngeal Insufficiency: A Longitudinal Comparative Analysis of More Than 1000 Operations

Rochlin, Danielle H; Sheckter, Clifford C.; Khosla, Rohit K.; Lorenz, H. Peter

doi:10.1097/prs.0000000000008193

Cited by 12 publications

(8 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…64,65 According to Swanson, who in 2015 66 states that severe cases of VPI associated with significant palatal foreshorting or limited palatal mobility typically require a more invasive intervention, open pharyngoplasty and palatoplasty techniques carry significant risk, including hemorrhage, oronasal fistula, and obstructive sleep apnea (OSA). 66,67 For patients with mild to moderate VPI and small velopharyngeal gaps instead, injection augmentation pharyngoplasty with AFG offers a low risk outpatient alternative. In a recent review of the literature, 14 de Baclam demonstrate that there is no significant difference in outcome across various surgical procedures for the treatment of VPI (palatal muscle repositioning, pharyngoplasty procedures, and posterior pharyngeal wall augmentation).…”

Section: Discussionmentioning

confidence: 99%

A Master Mind Game Code Algorithm Approach to Help Surgical Decision-Making between Retropharyngeal Fat Grafting and Pharyngoplasty for the Treatment of Velopharyngeal Incompetence

Suzzi

Gennaro

Baylon

et al. 2023

Int Arch Otorhinolaryngol

View full text Add to dashboard Cite

Introduction Velopharyngeal insufficiency (VPI) is a controversial pathology with many surgical options. Objective To compare pharyngoplasty and retropharyngeal fat grafting and to build a prognostic tool to achieve perfect speech. Methods Retrospective observational cohort study of 114 patients operated for VPI from 1982 to 2019 in a single tertiary center. The instrumental assessment was made using an aerophonoscope and nasofibroscopy. The variables sex, age, genetic syndromes, and type of diagnosis were analyzed with logistic regression model adjusted with propensity score. To generalize results and to build a surgical predictive tool, a marginal analysis concludes the study. Results Among the patients (median [range] age 7 [4–48]), 63 (55.26%) underwent pharyngoplasty and 51 (44.74%) graft. The graft group had no complication, but it had a failure rate of 7.84%. The pharyngoplasty group had no failure, but one patient had postoperative obstructive sleep apnea. The marginal analysis demonstrated that age lower than 7 years, cleft lip and palate, absence of syndrome, and intermittent VPI were important predictive factors of good result regardless of surgical technique. Conclusions Without a statistical demonstration of the superiority of pharyngoplasty over graft, and in the uncertainty of literature background, our perfect-speech patient profile represents an important tool for a postoperative forecast of results in which, like in the Master Mind game, every feature has to be considered not individually but as a pattern of characteristics whose association contributes to the outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

A Master Mind Game Code Algorithm Approach to Help Surgical Decision-Making between Retropharyngeal Fat Grafting and Pharyngoplasty for the Treatment of Velopharyngeal Incompetence

Suzzi

Gennaro

Baylon

et al. 2023

Int Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…9,20 While traditional operative management of VPD utilizes pharyngoplasty techniques to narrow the velopharyngeal space, these operations carry a known risk of airway obstruction and obstructive sleep apnea, with previous studies reporting postoperative OSA rates of 7-22%. 21,[33][34][35] Recent emphasis has been placed on restoring palatal length and function prior to the more obstructive pharyngoplasty procedures, 9,36,37 and newer studies of novel dynamic MRI techniques seek to evaluate additional factors which may guide procedure choice and optimize patient outcomes. [38][39][40] As a large pediatric center that has utilized multiple techniques with an evolution of procedure choice over time, our goal was to revisit our operative experience over the past 10 years and to study clinical predictors associated with speech outcomes and complication profiles.…”

Section: Discussionmentioning

confidence: 99%

Speech Outcomes Following Operative Management of Velopharyngeal Dysfunction (VPD) in Non-Syndromic Post-Palatoplasty Cleft Palate Patients

Kimia

Solot

McCormack

et al. 2023

The Cleft Palate Craniofacial Journal

View full text Add to dashboard Cite

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.

show abstract

“…OSA was second most common indication for revision pharyngoplasty in this cohort. Upper airway obstruction is a well-known morbidity associated with pharyngoplasty and is likely attributable to the decrease in pharyngeal diameter 21,22 . Rates of postoperative OSA have been shown to be equivalent when comparing SP to PPF; however, rates were significantly lower in patients who had undergone palatal lengthening procedures as compared with pharyngoplasty 22 .…”

Section: Discussionmentioning

confidence: 99%

“…21,22 Rates of postoperative OSA have been shown to be equivalent when comparing SP to PPF; however, rates were significantly lower in patients who had undergone palatal lengthening procedures as compared with pharyngoplasty. 22 Rates of obstruction after pharyngoplasty as high as 38% are reported in the early postoperative period, fortunately, for most patients, the upper airway obstruction resolves within several months. 21,23 For those whose obstruction does not resolve spontaneously after several months, secondary surgery is indicated.…”

Section: Discussionmentioning

confidence: 99%

“…Upper airway obstruction is a well-known morbidity associated with pharyngoplasty and is likely attributable to the decrease in pharyngeal diameter 21,22 . Rates of postoperative OSA have been shown to be equivalent when comparing SP to PPF; however, rates were significantly lower in patients who had undergone palatal lengthening procedures as compared with pharyngoplasty 22 . Rates of obstruction after pharyngoplasty as high as 38% are reported in the early postoperative period, fortunately, for most patients, the upper airway obstruction resolves within several months 21,23 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Revision Pharyngoplasty in Cleft Palate and Velopharyngeal Insufficiency

et al. 2022

View full text Add to dashboard Cite

Introduction Velopharyngeal insufficiency (VPI), a stigmatizing hallmark of palatal dysfunction, occurs in a wide spectrum of pediatric craniofacial conditions. The mainstays for surgical correction include palate repair and/or pharyngeal surgery. However, primary pharyngoplasty has a failure rate of 15% to 20%. Although revision pharyngoplasty may be necessary in those with persistent VPI, little is known regarding the indications for and outcomes after such procedures. The purpose of this study is to describe the authors' experience with indications for and outcomes after revision pharyngoplasty. Methods A single-center retrospective review was performed of all patients undergoing revision pharyngoplasty between 2002 and 2019. Demographic data and Pittsburgh Weighted Speech Scores, diagnoses, comorbidities, and complications were tabulated. Two-tailed Student t test was used, and a P value of 0.05 or less was considered statistically significant. Results Thirty-two patients (65.6% male) met inclusion criteria for this study. The most common diagnoses included cleft palate (68.8%), submucous cleft palate (SMCP, 18.8%), and congenital VPI (6.3%, likely occult SMCP). Most patients (84.4%) underwent palatoplasty before their initial pharyngoplasty. The primary indication for initial pharyngoplasty was VPI (mean age 7.1 ± 4.6 years). The most common indication for revision pharyngoplasty (mean age 11.2 ± 5.1 years) included persistent VPI (n = 22), followed by obstructive sleep apnea (OSA) (n = 11). Persistent VPI (n = 8) and OSA (n = 6) were the most common complications after secondary pharyngoplasty. Thirteen patients (40.6%) within the revision pharyngoplasty cohort required additional surgical intervention: 4 underwent tertiary pharyngoplasty, 4 underwent takedown for OSA (n = 3) or persistent VPI (n = 1), 3 underwent takedown and conversion Furlow for persistent VPI (n = 2), OSA (n = 2) and/or flap dehiscence (n = 1), and 2 underwent palatal lengthening with buccal myomucosal flaps for persistent VPI. Of the 4 patients who required a tertiary pharyngoplasty, the mean age at repair was 6.6 ± 1.1 years and their speech scores improved from 13.5 to 2.3 after tertiary pharyngoplasty (P = 0.11). The overall speech score after completion of all procedures improved significantly from 19 to 3.3. Conclusion Patients who fail primary pharyngoplasty represent a challenging population. Of patients who underwent secondary pharyngoplasty, nearly half required a tertiary procedure to achieve acceptable speech scores or resolve complications.

show abstract

Rates of Revision and Obstructive Sleep Apnea after Surgery for Velopharyngeal Insufficiency: A Longitudinal Comparative Analysis of More Than 1000 Operations

Abstract: urgery for velopharyngeal insufficiency is performed to improve speech; however, obstructive sleep and respiratory complications can be unintended consequences. The aperture of the velopharyngeal port can be conceptualized as a continuum, with velopharyngeal

Cited by 12 publications

References 48 publications

A Master Mind Game Code Algorithm Approach to Help Surgical Decision-Making between Retropharyngeal Fat Grafting and Pharyngoplasty for the Treatment of Velopharyngeal Incompetence

A Master Mind Game Code Algorithm Approach to Help Surgical Decision-Making between Retropharyngeal Fat Grafting and Pharyngoplasty for the Treatment of Velopharyngeal Incompetence

Speech Outcomes Following Operative Management of Velopharyngeal Dysfunction (VPD) in Non-Syndromic Post-Palatoplasty Cleft Palate Patients

Revision Pharyngoplasty in Cleft Palate and Velopharyngeal Insufficiency

Contact Info

Product

Resources

About