Cineradiographic assessment of combined island flap pushback and pharyngeal flap in the surgical management of submucous cleft palate

1970 ◽  
Vol 23 ◽  
pp. 39-44 ◽  
Author(s):  
John E. Hoopes ◽  
A. Lee Dellon ◽  
Jacob I. Fabrikant ◽  
Ann H. Soliman
Keyword(s):  
Cleft Palate ◽  
Surgical Management ◽  
Island Flap ◽  
Submucous Cleft Palate ◽  
Pharyngeal Flap

Submucous Cleft Palate: A Systematic Review of Surgical Management Based on Perceptual and Instrumental Analysis

2014 ◽  
Vol 51 (6) ◽  
pp. 686-695 ◽  
Author(s):  
Onur Gilleard ◽  
Debbie Sell ◽  
Ali M. Ghanem ◽  
Yasemin Tavsanoglu ◽  
Malcolm Birch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Surgical Management ◽  
Evidence Base ◽  
Velopharyngeal Insufficiency ◽  
Abnormal Development ◽  
Submucous Cleft Palate ◽  
Congenital Condition ◽  
Pharyngeal Flap ◽  
Speech Assessment

Objective Submucous cleft palate (SMCP) is a congenital condition associated with abnormal development of the soft palate musculature. In a proportion of cases, this results in velopharyngeal insufficiency (VPI), the treatment for which includes pharyngeal flap surgery, pharyngoplasty, and palate reconstruction. The aim of this paper is to determine whether there is superiority of one or more types of surgical procedure over the others in improving speech in patients with VPI secondary to SMCP. Methodology Nine databases, including MEDLINE and EMBASE, were searched between inception and January 2013 to identify articles published relating to the surgical management of SMCP. Only studies that reported outcome measures for postoperative speech were included in the systematic review. Results Twenty-six studies analyzing the outcomes of surgery for VPI in patients with SMCP met the inclusion criteria. In these studies, speech outcomes were measured either in a binary fashion (i.e., normal speech or evidence of VPI) or using scales of VPI severity. Of the 26 studies, only two utilized blinded speech assessment, and 12 included both preoperative and postoperative speech assessment. Conclusions The review found little evidence to support any specific surgical intervention. This is in large part due to the inclusion of mixed etiologies within study populations and the lack of unbiased validated preoperative and postoperative speech assessment. Further methodologically rigorous studies need to be conducted to provide a secure evidence base for the surgical management of SMCP.

Furlow Palatoplasty to Restore Velopharyngeal Competence following Tonsillectomy Avulsion of a Pharyngeal Flap

2001 ◽  
Vol 38 (1) ◽  
pp. 84-88
Author(s):  
Arun K. Gosain ◽  
Daniel Remmler
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Salvage Procedure ◽  
Flap Surgery ◽  
Routine Procedure ◽  
Port Closure ◽  
Mechanical Interference ◽  
Submucous Cleft Palate ◽  
Previously Treated ◽  
Pharyngeal Flap

Objective We report the successful use of a Furlow palatoplasty to salvage velopharyngeal competence following iatrogenic avulsion of a pharyngeal flap that had been previously established to treat velopharyngeal insufficiency associated with a submucous cleft palate. Intervention A tonsillectomy, conducted by a surgeon unaffiliated with a cleft palate team, was used to remove enlarged tonsils that had developed after pharyngeal flap surgery and extended into the lateral ports causing nasal obstruction and hypernasality because of mechanical interference with port closure. A posttonsillectomy evaluation revealed avulsion of the pharyngeal flap, which was successfully treated using a Furlow palatoplasty. Conclusions To our knowledge, this is the first report of iatrogenic avulsion of a pharyngeal flap caused by tonsillectomy. Based on a review of the literature and this case experience, we would conclude that tonsillectomy should not be regarded as a routine procedure in patients previously treated with a pharyngeal flap. If required, it should be performed by a skilled otolaryngologist, preferably one affiliated with a multidisciplinary cleft palate team who is familiar with pharyngoplasty surgery. Finally, our experience would suggest that the Furlow palatoplasty is sufficiently robust to be used as a secondary salvage procedure to restore velopharyngeal sufficiency following iatrogenic avulsion of a pharyngeal flap.

Comparison of the Speech Results After Correction of Submucous Cleft Palate With Furlow Palatoplasty and Pharyngeal Flap Combined With Intravelar Veloplasty

2018 ◽  
Vol 29 (1) ◽  
pp. e100-e103 ◽  
Author(s):  
Mert Calis ◽  
Galip Gencay Ustun ◽  
Mehtap Ozturk ◽  
Riza Onder Gunaydin ◽  
Mavis Emel Kulak Kayikci ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Submucous Cleft Palate ◽  
Pharyngeal Flap ◽  
Intravelar Veloplasty

Comparison of Resonance Outcomes after Pharyngeal Flap and Furlow Double-Opposing Z-Plasty for Surgical Management of Velopharyngeal Incompetence

2006 ◽  
Vol 43 (1) ◽  
pp. 38-43 ◽  
Author(s):  
Scott A. Dailey ◽  
Michael P. Karnell ◽  
Lucy Hynds Karnell ◽  
John W. Canady
Keyword(s):  
Retrospective Study ◽  
Cleft Palate ◽  
Surgical Management ◽  
Surgical Procedures ◽  
University Of Iowa ◽  
Velopharyngeal Incompetence ◽  
Appropriate Treatment ◽  
Significant Difference ◽  
Pharyngeal Flap ◽  
Selection Of

Objective The purpose of this study was to test the hypothesis that no significant difference exists in the speech outcomes between patients with severe velopharyngeal incompetence (VPI) who receive a pharyngeal flap and patients with less severe VPI who receive a Z-plasty for management of VPI. Design This retrospective study from 1993 to 2002 included a review of pre- and postoperative perceptual speech and resonance assessments of patients with marginal VPI who received a Furlow double-opposing Z-plasty and patients with VPI who received a pharyngeal flap. Setting All patients had surgical management of VPI at the Cleft Palate– Craniofacial Clinic at University of Iowa Hospitals and Clinics. Results Both groups benefited from surgery with significant reduction in perceived hypernasality (p < .001). Comparison of postoperative assessments indicated no difference between the groups in hypernasality or hyponasality ratings. Neither group had a significant increase in hyponasality. Conclusion Both pharyngeal flap and double-opposing Z-plasty proved equally effective at reducing hypernasality when the selection of the surgical procedures was based on preoperative ratings of perceived hypernasality and evaluation of velopharyngeal physiology. Severity of the VPI is an important factor when considering surgical management of VPI. Thorough preoperative evaluations of patients with VPI are essential in appropriate treatment planning.

Palatal pushback and lateral pharyngoplasty in surgical management of submucous cleft palate

1982 ◽  
Vol 6 (3) ◽  
pp. 165-174 ◽  
Author(s):  
Sadao Tsukada ◽  
Kouichi Yamashita ◽  
Noriko Ainoda
Keyword(s):  
Cleft Palate ◽  
Surgical Management ◽  
Submucous Cleft Palate ◽  
Lateral Pharyngoplasty

Treatment of Velopharyngeal Inadequacy in a Patient with Submucous Cleft Palate and Myasthenia Gravis

2009 ◽  
Vol 46 (5) ◽  
pp. 558-562 ◽  
Author(s):  
Naoaki Rikihisa ◽  
Akikazu Udagawa ◽  
Shinya Yoshimoto ◽  
Masaharu Ichinose ◽  
Tomoe Kimura ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Cleft Palate ◽  
Flap Surgery ◽  
Cleft Palate Speech ◽  
Air Emission ◽  
Velopharyngeal Incompetence ◽  
Initial Surgery ◽  
Submucous Cleft Palate ◽  
Pharyngeal Flap

Objective: To describe the clinical course and management of a patient with submucous cleft palate who developed myasthenia gravis (MG) as an adult and suffered recurrent hypernasality. Few reports have described MG patients undergoing pharyngeal flap surgery for velopharyngeal incompetence, and these have described only slight speech improvement in such patients. Design: Case report. Patient: The patient underwent primary pushback palatoplasty and superiorly based pharyngeal flap surgery for submucous cleft and short palate at age 7. Hypernasality showed major improvement after initial surgery. At age 19, the patient developed MG that triggered the recurrence of velopharyngeal incompetence. Intervention: After MG was treated, revision pushback palatoplasty was performed for velopharyngeal incompetence when the patient was 24 years old. Preoperatively and postoperatively, the patient was evaluated by the same speech-language-hearing therapists, each with at least 5 years of clinical experience in cleft palate speech. Results: After the second pushback palatoplasty, hypernasality and audible nasal air emission during speech decreased to mild. Conclusion: Primary pushback palatoplasty and pharyngeal flap surgery were performed for the submucous cleft palate. Revision pushback palatoplasty improved velopharyngeal inadequacy induced by MG. Decreased perceived nasality positively influenced the patient's quality of life. Combined pushback palatoplasty and pharyngeal flap surgery is thus an option in surgical treatment for velopharyngeal inadequacy to close the cleft and the velopharyngeal orifice in cases of cleft palate and MG.

Surgical Management of a Rare Variant of Submucous Cleft Palate

2012 ◽  
Vol 23 (6) ◽  
pp. e642-e643
Author(s):  
Rakesh Sharma ◽  
Sriram Krishnan ◽  
Pankaj Sharma ◽  
Mahesh Verma ◽  
Zainab Chaudhary
Keyword(s):  
Cleft Palate ◽  
Surgical Management ◽  
Rare Variant ◽  
Submucous Cleft Palate

scholarly journals The efficacy of transnasal palatal transillumination for the diagnosis of submucous cleft palate

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Yasir S. Jamal ◽  
Sabah S. Moshref ◽  
Abeer M. Baamir ◽  
Mazin O. Kurdi ◽  
Doaa Y. Jamal
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Diagnostic Techniques ◽  
Lateral Release ◽  
Feeding Difficulties ◽  
Presenting Symptoms ◽  
Submucous Cleft Palate ◽  
Cheap Method ◽  
Operative Findings ◽  
Simple Repair

Abstract Background Submucous cleft palate (SMCP) is a congenital abnormality with various clinical and anatomical features. Submucous cleft pathologies may be unrecognized during routine examinations. Current diagnostic techniques are constrained and unrevealing in presurgical patients. This prospective study aimed to evaluate transnasal palatal transillumination technique in diagnosis of SMCP at our institute hospital, during period from 2005-2020. Patients and methods Twenty-one cases with SMCP were recruited with age range from 2-60 months. Transnasal palatal transillumination with controllable light intensity endoscope used to evaluate SMCP and cases were photo and video recorded. Results In this study, 21 cases (13 males and 8 females) with SMCP were detected or confirmed by intranasal transnasal palatal transillumination. Frequency of SMCP patients at our institute was 3.39%. All patients presented with symptomatic complaints at diagnosis time, apart from 5 patients (23.8%) were diagnosed during cleft lip repair operations. Presenting symptoms were hypernasality (23.8%), delayed speech (23.8%), perforated palate with nasal escape of milk and food (14.3%), feeding difficulties (14.3%), and otitis media (4.8%). During intra-oral examination, all cases had a bifid uvula accompanied SMCP. Submucous cleft palate appeared as thin palate with central lucency. According to operative findings, operations done for repair were mostly two long palatal flaps (n = 13, 61.9%), von Langenbeck (n = 5, 23.8%), simple repair with lateral release incisions (n = 2, 9.6%), and simple repair without lateral release incision (n = 1, 4.8%). Conclusions Intraoperative assessment of submucous cleft palate with transnasal palatal transillumination is easy and cheap method to avoid missing cases of SMCP.

Sign in / Sign up

Export Citation Format

Share Document