Revision Rates and Speech Outcomes Following Pharyngeal Flap Surgery for Velopharyngeal Insufficiency

Setabutr, Dhave; Roth, Christina; Nolen, David; Cervenka, Brian; Sykes, Jonathan M.; Senders, Craig W; Tollefson, Travis Tate

doi:10.1001/jamafacial.2015.0093

Cited by 33 publications

(14 citation statements)

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“…The majority of these were patients with 22q11 microdeletion (Argamaso et al, 1994; Arneja et al, 2008; Boneti et al, 2015; Brandao et al, 2011; Chegar et al, 2007; Crockett et al, 2014; Ettinger et al, 2012; Filip et al, 2013b; Leboulanger et al, 2011; Mehendale et al, 2004; Piotet et al, 2015; Rouillon et al, 2009; Setabutr et al, 2015; Shprintzen, 1988; Sie et al, 1998; Spruijt et al, 2012b). One study looked at management of patients with myotonic dystrophy (Amir et al, 1999), whereas others included patients with rarer syndromes such as Nager (Leboulanger et al, 2011), Sotos (Gray et al, 1999), and Kabuki and Diamond-Blackfan (Setabutr et al, 2015). A small number of papers included results for patients with unspecified syndromes.…”

Section: Resultsmentioning

confidence: 99%

Surgery for Velopharyngeal Dysfunction

Blacam

Smith

Orr

2017

The Cleft Palate Craniofacial Journal

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Objective: This systematic review sought to evaluate the consensus in the literature regarding the surgical management of VPD and to determine whether a particular procedure results in superior speech outcome or less morbidity Design: A systematic review was carried out according to PRISMA-P guidelines. Systematic review software was used to facilitate 3-stage screening and data extraction by 2 reviewers.Setting: University teaching hospital.Patients, Participants: Studies that reported perceptual speech assessment or obstructive sleep apnea (OSA) in patients who had undergone surgery for VPD were included in the review. Interventions: Four categories of surgery for VPD were examined-pharyngeal flap, sphincter pharyngoplasty, palatoplasty, and posterior pharyngeal wall augmentation.Main outcome measures: Perceptual speech assessment, need for further surgery, and occurrence of OSA were the outcomes of interest.Results: Eighty-three relevant studies were identified, comprising data on 4011 patients. Pharyngeal flap was the most common procedure (64% of patients). Overall, 70.7% of patients attained normal resonance and 65.3% attained normal nasal emission. There was no notable difference in speech outcomes, need for further surgery, or occurrence of OSA across the 4 categories of surgery examined. Heterogeneous groups of patients were reported upon and a variety of perceptual speech assessment scales were used. Conclusions: There is a lack of consensus in the literature to guide procedure selection for patients with VPD. The development of a standardized minimum data set to record postoperative speech, OSA, and patient-reported outcomes is required.

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Section: Resultsmentioning

confidence: 99%

Surgery for Velopharyngeal Dysfunction

Blacam

Smith

Orr

2017

The Cleft Palate Craniofacial Journal

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“…3,4 However, even after repair, 20% to 30% of children with cleft palate will have persistent VPI. 5 Correcting cleft speech is very important for the child's future ability to live independently and to participate fully in society. Children with orofacial clefts have been shown to have greater behavioral problems and overall social and academic problems, increased symptoms of depression, and are more likely to be teased.…”

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confidence: 99%

Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery

Bhuskute

Skirko

Roth

et al. 2017

JAMA Facial Plast Surg

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IMPORTANCE Patients with cleft palate and other causes of velopharyngeal insufficiency (VPI) suffer adverse effects on social interactions and communication. Measurement of these patient-reported outcomes is needed to help guide surgical and nonsurgical care.OBJECTIVES To further validate the VPI Effects on Life Outcomes (VELO) instrument, measure the change in quality of life (QOL) after speech surgery, and test the association of change in speech with change in QOL. DESIGN, SETTING, AND PARTICIPANTSProspective descriptive cohort including children and young adults undergoing speech surgery for VPI in a tertiary academic center. Participants completed the validated VELO instrument before and after surgical treatment. MAIN OUTCOMES AND MEASURESThe main outcome measures were preoperative and postoperative VELO scores and the perceptual speech assessment of speech intelligibility. The VELO scores are divided into subscale domains. Changes in VELO after surgery were analyzed using linear regression models. VELO scores were analyzed as a function of speech intelligibility adjusting for age and cleft type. The correlation between speech intelligibility rating and VELO scores was estimated using the polyserial correlation.RESULTS Twenty-nine patients (13 males and 16 females) were included. Mean (SD) age was 7.9 (4.1) years (range, 4-20 years). Pharyngeal flap was used in 14 (48%) cases, Furlow palatoplasty in 12 (41%), and sphincter pharyngoplasty in 1 (3%). The mean (SD) preoperative speech intelligibility rating was 1.71 (1.08), which decreased postoperatively to 0.79 (0.93) in 24 patients who completed protocol (P < .01). The VELO scores improved after surgery (P<.001) as did most subscale scores. Caregiver impact did not change after surgery (P = .36). Speech Intelligibility was correlated with preoperative and postoperative total VELO score (P < .01) and to preoperative subscale domains (situational difficulty [VELO-SiD, P = .005] and perception by others [VELO-PO, P = .05]) and postoperative subscale domains (VELO-SiD [P = .03], VELO-PO [P = .003]). Neither the VELO total nor subscale score change after surgery was correlated with change in speech intelligibility.CONCLUSIONS AND RELEVANCE Speech surgery improves VPI-specific quality of life. We confirmed validation in a population of untreated patients with VPI and included pharyngeal flap surgery, which had not previously been included in validation studies. The VELO instrument provides patient-specific outcomes, which allows a broader understanding of the social, emotional, and physical effects of VPI.LEVEL OF EVIDENCE 2.

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“…21 This procedure was found to have a revision rate of 20%, with increased age at the time of surgery significantly associated with need for revision surgery. 22 An alternate palate splitting technique is depicted in ►Fig. 2.…”

Section: Surgical Treatmentmentioning

confidence: 99%

State of the Art in Treating Velopharyngeal Dysfunction

2016

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Velopharyngeal dysfunction (VPD) is a condition that can greatly impact a child's quality of life. The initial evaluation and workup of patients presenting with VPD is generally straightforward, consisting of history taking and physical examination, perceptual speech analysis, and objective techniques such as nasometry and speech endoscopy. However, there is no standardized treatment option. Multiple surgical and nonsurgical techniques have been described, all with varying approaches to correction of the defect and similarly, with varying risks and outcomes. We aim to provide an overview of this condition and available treatment options, as well as highlight recent updates in management, including the use of cine magnetic resonance imaging, new injectable options for pharyngeal augmentation, and the evolving role of robotic surgery. We also discuss techniques to facilitate teaching during oropharyngeal surgery and our approach to revision surgical planning.

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Revision Rates and Speech Outcomes Following Pharyngeal Flap Surgery for Velopharyngeal Insufficiency

Cited by 33 publications

References 15 publications

Surgery for Velopharyngeal Dysfunction

Surgery for Velopharyngeal Dysfunction

Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery

State of the Art in Treating Velopharyngeal Dysfunction

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