Velar Closing Ratio As a Predictor for the Verlopharyngeal Function After Double Opposing Z-Plasty for Postpalatoplasty Velopharyngeal Insufficiency in Patients With Cleft Palate

Abstract

Background: This study was designed to identify the potential predictors of postoperative velopharyngeal function after double opposing Z-plasty (DOZP) for the treatment of velopharyngeal insufficiency (VPI) in patients who had prior palatoplasty for cleft palate. Methods: This retrospective study reviewed the medical records of consecutive patients who received DOZP for VPI after receiving a prior palatoplasty treating cleft palate between 2004 and 2017. The speech outcome of patient was measured using the Pittsburgh Weighted Speech Scale (PWSS) at 6 months following surgery and determined the outcome suggests velopharyngeal competence (PWSS ≤2) or incompetence (PWSS >2). Stepwise logistic regression was used to identify the variables for the prediction of competent surgical outcome. The specific receiver operating characteristic curves with an area under the curve (AUC) was used to evaluate the predictor related to the surgical outcome as competence. Results: The study included 93 patients. Age, relative velar length, velar lengthening, and closure pattern were not significantly associated with postoperative competence status of the patient. The only variable that predicted a successful surgical outcome was preoperative velar closing ratio. However, the accuracy of velar closing ratio in predicting a competent surgical outcome is only moderate (AUC = 70.37). Conclusion: The results of this study showed that preoperative velar closing ratio may predict, with moderate accuracy, a successful surgical outcome in patients with postpalatoplasty VPI who undergo DOZP. Therefore, in patients with a low preoperative velar closing ratio, some alternative surgical methods other than DOZP may be considered to avoid unsatisfactory surgical outcome.

“Buccal Myomucosal Flap Repair for Velopharyngeal Dysfunction.”

“…17,18 Wu et al recently showed that velar closing ratio is an important predictor of hypernasality resolution in VPD treatment with double-opposing Z-plasties. 19 They noted, however, that the accuracy of velar closing ratio in predicting surgical success is only moderate, a result recapitulated by our analysis: the three patients with abnormal speech scores had relatively low velar closures (<40%) preoperatively, but others within this range had satisfactory results, suggesting that velar closure is not the sole element responsible for postoperative hypernasal speech.…”

Prognostic Factors for Speech Outcome among Patients with Submucous Cleft Palate Managed by Furlow Palatoplasty or Posterior Pharyngeal flap

“…20 Its effect on the FP outcome in correction of overt cleft palate or secondary VPI has been proven by numerous studies but is inconclusive among the SMCP population. 6,20,29,60,65,66 In this study, preoperative VCR was not indicated as predictive of FP outcome.…”

“…19,27 Besides surgical timing and techniques, various other factors have been proposed as potentially correlated to SMCP outcome, including preoperative velopharyngeal closure ratio (VCR), closure patterns, and severity of anatomic abnormalities and syndromes. 12,[28][29][30] Relevant studies, however, have reported mixed results, and are often confounded by inconsistency of inclusion criteria and relatively small sample size. 28,31 Identification and thorough understanding of prognostic factors is important to the risk-to-benefit evaluation of the SMCP management algorithm.…”

How Early Can We Predict the Need for VPI Surgery?

“…However, better outcomes in younger patients have not been observed in all studies. [36][37][38][39] Nevertheless, VPI results in poor quality-of-life for patients and their parents, 40 and children with severe hypernasality have improved quality-of-life after VPI surgery. 41 Moreover, speech disorders in patients with CP, such as compensatory articulation, may become incorporated into the child's developing phonological rule system and produce a phonological disorder.…”