Surgery for Velopharyngeal Dysfunction

Abstract

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.

Through-and-Through Dissection of the Soft Palate for Pharyngeal Flap Inset: A “Good-Fast-Cheap” Technique for Any Etiology of Velopharyngeal Incompetence

“…Complication rates. Pharyngeal flaps are the most commonly reported procedure for VPI (49% of studies), with the highest rates of OSA (5.1%) and lowest rates of revisional surgery required (6.1%; de Blacam et al, 2018). A recent study using the 2012 American College of Surgeons National Surgical Quality Improvement Program Pediatric database identified the overall perioperative complication rate for posterior pharyngeal flap surgery to be low (5.3%) and identified patients with underlying cardiac risk factors, severe American Society of Anesthesiologists Physical Status class, and asthma as having heightened risk profiles (Swanson et al, 2016) Our major complication rate of 3% OSA and 3% rate of reoperation compare favorably to these studies in the literature.…”

“…Incomplete closure during speech leads to air escape causing hypernasality, increased nasal resonance, and decreased intelligibility (Ruda et al, 2012). Furthermore, children with untreated VPI may develop secondary sequelae, including compensatory speech misarticulations (glottal stops and pharyngeal fricatives), softness of voice, and laryngeal nodules due to increased laryngeal airflow (Hogan, 1973;Kummer et al, 2015;de Blacam et al, 2018). Decreased intelligibility from VPI adversely affects patients' schooling, work, and psychosocial health and negatively impacts children's quality of life (Sloan, 2000;Leclerc et al, 2014).…”

“…The pharyngeal flap is the most described surgical technique for the management of VPI, designed to create an incomplete central velopharyngeal obstruction that permits peripheral airflow between the oral and nasal cavities during phonation (Setabutr et al, 2015;de Blacam et al, 2018). Since Schönborn (1875) first described an inferiorly based pharyngeal flap, the pharyngeal flap has been a mainstay in speech surgery.…”

Non-Interventional Factors Influencing Velopharyngeal Function For Speech In Initial Cleft Palate Repair: A Systematic Review Protocol

“…Systematic reviews performed in this area [3] have identified significant diversity of methodology and reporting of results. Consequently, it is anticipated that there will be substantial heterogeneity and that a formal meta-analysis will not be feasible.…”

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

“…13 The majority of studies in the literature report perceptual speech assessment using a nonvalidated, in-house scale. 14 The diagnosis of VPI must be multidisciplinary: speech and instrumental assessment must be combined. Regarding instrumental assessment, every institution chose between a combination of nasoendoscopy (NE) alone, multiplanar videofluoroscopy (MPVF) alone or a combination of the two.…”