Pharyngeal flap for a poorly repaired cleft palate with posterior palatal defect

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft. This review contains 1 figure, 3 videos, and 58 references. Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction

Download Full-text

Incidence and Severity of Obstructive Sleep Apnea following Pharyngeal Flap Surgery in Patients with Cleft Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2002_039_0312_iasoos_2.0.co_2 ◽

2002 ◽

Vol 39 (3) ◽

pp. 312-316 ◽

Cited By ~ 30

Author(s):

Yu-Fang Liao ◽

Ming-Lung Chuang ◽

Philip K.T. Chen ◽

Ning-Hung Chen ◽

Claudia Yun ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Palate ◽

Flap Surgery ◽

Adult Group ◽

Child Group ◽

Obstructive Sleep ◽

Pharyngeal Flap ◽

Respiratory Disturbance ◽

Different Levels

Objective: To investigate the incidence and severity of obstructive sleep apnea (OSA) associated with pharyngeal flap surgery in patients with cleft palate at least 6 months postoperatively and to determine whether age or the flap width had an effect on them. The hypothesis tested in this study was that the severity of OSA associated with pharyngeal flap surgery is greater in children than in adults. Subjects: Ten adults, six men and four women, with a mean age of 28.0 years at pharyngeal flap (adult group). Twenty-eight children, 13 boys and 15 girls, with a mean age of 6.3 years at pharyngeal flap (child group). Design: A prospective analysis. Main Outcome Measures: An overnight polysomnographic study was used to determine the incidence and severity of OSA 6 months after pharyngeal flap. Results: The incidence of OSA following pharyngeal flap was high but not significantly different between these two groups (90% in adults and 93% in children, p = 1.000). When OSA was stratified into different levels of severity according to the values of respiratory disturbance index, there were noticeable differences between these two groups (p = .022). In the adult group, eight patients (89%) had mild OSA and 1 patient (11%) had moderate to severe OSA. In the child group, 11 patients (42%) were found to have mild OSA, and 15 patients (58%) had moderate to severe OSA. No relation was found between the flap width and the incidence (p = .435 in adults and .640 in children) or the severity (p = .325 in adults and .310 in children) of OSA in each group. Conclusions: Six months following pharyngeal flap surgery, more than 90% of the patients with cleft palate still had OSA. The severity of OSA associated with pharyngeal flap surgery tended to be greater in children than in adults. The flap width was unrelated to the incidence and severity of OSA, no matter in adults or in children.

Download Full-text

Objective, Noninvasive Evaluation of Velopharyngeal Function in Cleft and Noncleft Patients

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1998_035_0035_oneovf_2.3.co_2 ◽

1998 ◽

Vol 35 (1) ◽

pp. 35-39 ◽

Cited By ~ 2

Author(s):

Martin Kunkel ◽

Ulrich Wahlmann ◽

Wilfried Wagner

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Noninvasive Evaluation ◽

Control Group ◽

Pharyngeal Muscles ◽

Pharyngeal Flap ◽

The Difference ◽

Acoustic Pharyngometry ◽

Velopharyngeal Function

Objective The purpose of this study was to investigate a new diagnostic method that provides an approach to noninvasive, objective measurement of velopharyngeal movement by acoustic determination of epipharyngeal volume changes with velopharyngeal muscle function. Design This was a case control study, using consecutive samples. Setting This study took place at the Cleft Palate Rehabilitation Center of the University of Mainz, Germany. Patients Subjects were 29 consecutive cleft lip and palate (CLP) patients and 31 controls (21 patients with dysgnathia and 10 healthy volunteers). Intervention A series of transnasal acoustic measurements (pressure wave: 55 dB for 2 milliseconds) of epipharyngeal volume were performed with the pharyngeal muscles relaxed in end-expiration and while the velopharyngeal orifice was closed, with the difference in volume representing maximal pharyngeal movement. Results Cleft palate patients yielded significantly lower values of velopharyngeal movement (6.5 cm3) than did the control group (8.0 cm3)(p < .05; Mann-Whitney U test). Overlapping ranges of values were measured for the C(L)P and control groups. The least mobility (4.75 cm3) was measured in patients who had undergone pharyngeal flap surgery. Different patterns of restriction were observed in patients with and without a pharyngeal flap. Conclusion Acoustic pharyngometry may provide access to noninvasive quantitative measurement of velopharyngeal movement and a better understanding of the pattern of movement in C(L)P-patients. We expect it to be a helpful tool in objectively monitoring the progress of logopedic therapy.

Download Full-text

Comparison of Obstructive Sleep Apnea Syndrome in Children with Cleft Palate following Furlow Palatoplasty or Pharyngeal Flap for Velopharyngeal Insufficiency

The Cleft Palate-Craniofacial Journal ◽

10.1597/02-162 ◽

2004 ◽

Vol 41 (2) ◽

pp. 152-156 ◽

Cited By ~ 52

Author(s):

Yu-Fang Liao ◽

M. Samuel Noordhoff ◽

Chiung-Shing Huang ◽

Philip K. T. Chen ◽

Ning-Hung Chen ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Palate ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Velopharyngeal Insufficiency ◽

Obstructive Sleep ◽

The Mean ◽

Pharyngeal Flap ◽

Apnea Syndrome

Objective To evaluate the incidence and severity of obstructive sleep apnea syndrome (OSAS) in patients with cleft palate having a Furlow palatoplasty or pharyngeal flap for correction of velopharyngeal insufficiency (VPI). Patients A total of 48 nonsyndromic children with repaired cleft palate with VPI were enrolled in the study. Twenty of the children had a Furlow palatoplasty (F group) and 28 children had a pharyngeal flap (P group) for correction of VPI. Interventions An overnight polysomnography evaluation was done to evaluate the incidence and severity of OSAS 6 months or more postoperatively. Main Outcome Measures Symptoms of OSAS, respiratory disturbance index (RDI), oxyhemoglobin desaturation index (DI), and sleep stages were measured. Results In the P group, the mean percentage of stage 2 sleep was lower than the F group (p < .05). The mean RDI and DI were larger in the P group, compared with the F group (p < .001). The incidence and severity of OSAS were higher in the P group, compared with the F group (p < .001 and p = 0.05, respectively). Conclusions A Furlow palatoplasty should be used in deference to a pharyngeal flap whenever possible on the basis of the preoperative evaluation of VPI because of the decreased incidence and severity of OSAS.

Download Full-text