Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty

2019 ◽  
Vol 4 (5) ◽  
pp. 878-892
Author(s):  
Joseph A. Napoli ◽  
Linda D. Vallino
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
A Priori ◽  
Sufficient Evidence ◽  
Obstructive Sleep ◽  
Before And After ◽  
Buccal Flap

Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

Septoplasty for Obstructive Sleep Apnea in Infants after Cleft Lip Repair

1996 ◽  
Vol 33 (6) ◽  
pp. 473-476 ◽  
Author(s):  
Gary D. Josephson ◽  
Jamie Levine ◽  
Court B. Cutting
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Septum ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Septal Deviation ◽  
Facial Growth ◽  
Deviated Nasal Septum ◽  
Obstructive Sleep ◽  
Cleft Lip Repair

A neonate with a unilateral cleft lip and palate usually presents with a deviated nasal septum due to the asymmetric bony base associated with cleft palate. Prior to repair, the facial cleft offers a wide open breathing passage despite the septal deviation. Cleft lips are traditionally repaired in neonates at about 3 months of age. These patients usually do not present with significant symptoms of nasal obstruction following repair, except in unusual cases. Severe septal deviation may cause obstructive sleep apnea. Repair of septal deformities in children is controversial due to the potential alteration of facial growth. We present two patients with documented obstructive sleep apnea that began after cleft lip repair. Conservative surgical correction of the septal deviation resulted in relief of the sleep apnea.

Symptoms of Obstructive Sleep Apnea, Nasal Obstruction, and Enuresis in Children With Nonsyndromic Cleft Lip and Palate: A Prevalence Study

2018 ◽  
Vol 56 (3) ◽  
pp. 307-313 ◽  
Author(s):  
Marilyse de Bragança Lopes Fernandes ◽  
Alícia Graziela Noronha Silva Salgueiro ◽  
Eliete Janaína Bueno Bighetti ◽  
Ivy Kiemle Trindade-Suedam ◽  
Inge Elly Kiemle Trindade
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Pediatric Population ◽  
Care Center ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Obstructive Sleep

Objective: To estimate the prevalence of symptoms of obstructive sleep apnea (OSA), nasal obstruction, and enuresis in children with nonsyndromic unilateral cleft lip and palate. Design: Prospective cross-sectional study. Setting: Referral care center. Participants: One hundred seventy-four children aged 6 to 12 years of both genders. Interventions: Symptoms of OSA and nasal obstruction were investigated by analysis of scores obtained by the Sleep Disturbance Scale for Children (SDSC) and Congestion Quantifier (CQ-5). Enuresis was considered as present when urinary loss was reported during sleep (at least 1 episode/month, last 3 months). To characterize the enuresis as mono- or polysymptomatic, symptoms of dysfunction of the lower urinary tract (DLUT) were investigated by the Dysfunctional Voiding Scoring System (DVSS). Statistical analysis was performed at a 5% level of significance. Results: Positive SDSC scores for OSA were observed in 60 (34%) children; positive CQ-5 scores for nasal obstruction in 45 (26%), positive DVSS scores for DLUT in 30 (17%), and enuresis was reported by 29 (17%), being categorized as primary in 66% and polysymptomatic in 72% of the children. Compared to the pediatric population, OSA, nasal obstruction, and enuresis prevalence ratios were up to 7 (95% confidence interval [CI] 5-9), 2 (95% CI 2-3), and 3 times (95% CI 2-5) higher, respectively. There was a positive/moderate correlation between symptoms of OSA and nasal obstruction ( P = .0001). No correlation was seen between symptoms of OSA and enuresis. Conclusions: Children with nonsyndromic cleft lip and palate have high prevalence of nasal obstruction and enuresis and are at risk of OSA.

Comparison of Positive Screening for Obstructive Sleep Apnea in Patients With and Without Cleft Lip and Palate

2019 ◽  
Vol 57 (3) ◽  
pp. 364-370
Author(s):  
Hande Gorucu-Coskuner ◽  
Banu Saglam-Aydinatay ◽  
Muge Aksu ◽  
Fatma Figen Ozgur ◽  
Tulin Taner
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Breast Feeding ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Bottle Feeding ◽  
Control Group ◽  
Feeding Duration ◽  
Obstructive Sleep ◽  
Cleft Lip Palate

Objective: To compare the prevalence of increased risk of obstructive sleep apnea (OSA) in children with and without cleft lip and/or palate using a previously validated questionnaire and to examine the clinical and demographic variables that may lead to increased OSA risk. Design: Prospective, cross-sectional study. Participants: One hundred fifty-five cleft lip palate and 155 noncleft children between 2 and 18 years old. Interventions: The Pediatric Sleep Questionnaire (PSQ): Sleep Related Breathing Disorder Scale was used for screening of increased OSA risk. Age, body mass index (BMI), gender, breast-feeding, and bottle-feeding durations were recorded for all patients. Cleft type, lip and palate operation times, nasoalveolar molding, or nutrition plaque usage was documented for the cleft lip palate group. Pearson χ2 or Fisher exact test was used for the evaluation of the qualitative variables and independent samples t test or Mann Whitney U test for quantitative variables. P < .05 was accepted as statistically significant. Results: The mean ages were 7.52 ± 3.91 and 7.50 ± 3.89 years for cleft lip palate and control groups, respectively. No significant differences were observed between the groups for age, gender, or BMI. Breast-feeding duration was significantly higher, and bottle-feeding duration was lower in the control group ( P < .05). Mean PSQ score was significantly higher in cleft lip palate group (0.18 ± 0.12) than in control group (0.13 ± 0.1, P < .001); and prevalence of increased OSA risk was significantly higher in patients with both cleft lip and palate ( P = .020). Conclusions: Positive OSA screening ratio of children with cleft lip and palate (12.2%) was significantly higher than the controls (4.5%).

Craniofacial, Craniocervical, and Pharyngeal Morphology in Bilateral Cleft Lip and Palate and Obstructive Sleep Apnea Patients

2007 ◽  
Vol 44 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Barbara C. M. Oosterkamp ◽  
Hendrik J. Remmelink ◽  
Gerard J. Pruim ◽  
Aarnoud Hoekema ◽  
Pieter U. Dijkstra
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Hyoid Bone ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Reference Group ◽  
Obstructive Sleep ◽  
Lateral Cephalograms ◽  
Bilateral Cleft Lip

Objective: The aim of this study was to analyze craniofacial, craniocervical, and pharyngeal morphology in surgically treated bilateral cleft lip and palate (BCLP) men, untreated men with obstructive sleep apnea (OSA), and a reference group of men. Subjects and methods: Lateral cephalograms were obtained of 27 male BCLP patients (mean age 29.0 ± 8.3 years), 27 untreated male OSA patients (mean age 38.6 ± 5.3 years), and 27 male controls serving as a reference group (mean age 30.8 ± 9.2 years). Tracings were made, and 26 variables representing craniofacial, craniocervical, and pharyngeal dimensions were obtained using Viewbox 3.1.1.6. software. The groups were compared using a one-way analysis of variance. Results: Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients was similar except for a significantly more retrusive maxilla in the BCLP group. Compared to the reference group, the BCLP and OSA groups had significantly larger craniocervical angulations, smaller depth of the oropharynx at the tip of the velum, and a more inferiorly positioned hyoid bone. Significantly larger vertical dimensions were found in the BCLP group compared to the reference group. Conclusions: Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients demonstrate substantial similarities except for a significantly more retrusive maxilla in the BCLP group. It is suggested that airway obstruction and postural adaptation to the obstruction may possibly be related to the aberrant craniofacial, craniocervical, and pharyngeal morphology in OSA and in BCLP patients.

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