Blinded Speech Evaluation following Pharyngeal Flap Surgery by Speech Pathologists and Lay People in Children with Cleft Palate

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.

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

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2001_038_0084_fptrvc_2.0.co_2 ◽

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.

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Comparison of Velopharyngeal Growth Patterns between Cleft Lip and/or Palate Patients Requiring or Not Requiring Pharyngeal Flap Surgery

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1994_031_0452_covgpb_2.3.co_2 ◽

1994 ◽

Vol 31 (6) ◽

pp. 452-460 ◽

Cited By ~ 7

Author(s):

Mohammad Mazaheri ◽

Athanasios E. Athanasiou ◽

Ross E. Long

Keyword(s):

Cleft Palate ◽

Soft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Growth Curves ◽

Growth Patterns ◽

Flap Surgery ◽

Velopharyngeal Incompetence ◽

Lateral Cephalograms ◽

Pharyngeal Flap

This investigation compares the patterns of velopharyngeal growth in cleft lip and/or palate patients. Those who had velopharyngeal competence and acceptable speech are compared with those who presented with velopharyngeal incompetence requiring pharyngeal flap surgery or prosthesis later. Lateral cephalograms of 30 cleft palate only (CPO), 35 unilateral cleft lip and palate (UCLP), and 20 bilateral cleft lip and palate (BCLP) children of the Lancaster Cleft Palate Clinic were studied. These records were taken at 6 month intervals during the first 2 postnatal years and annually thereafter up to 6 years of age. Soft tissue landmark points in the velopharyngeal region were digitized. Length and thickness of the soft palate and height and depth of the nasopharynx were measured. Evaluation of the growth curves of these four cephalometric variables indicated only two significant differences between children who later required pharyngeal flap surgery and those who did not. These differences were found in the growth in length of the soft palate of the CPO group and in the growth in depth of the nasopharynx of the BCLP group. Based on the present cephalometric data, it is Impossible to predict at an early age those cleft lip and/or palate patients who will later require pharyngeal flaps.

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Conditioned Dysphagia in Cleft Palate Children After Pharyngeal Flap Surgery

Psychosomatic Medicine ◽

10.1097/00006842-198207000-00003 ◽

1982 ◽

Vol 44 (3) ◽

pp. 247-257 ◽

Cited By ~ 12

Author(s):

William J. Di Scipio ◽

Karen Kaslon

Keyword(s):

Cleft Palate ◽

Flap Surgery ◽

Pharyngeal Flap

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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 ~ 50

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 ◽

Obstructive Sleep ◽

Pharyngeal Flap

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EDITORIAL. SOME THOUGHTS ON POSTERIOR PHARYNGEAL FLAP SURGERY IN THE TREATMENT OF CLEFT PALATE

Plastic & Reconstructive Surgery ◽

10.1097/00006534-196010000-00010 ◽

1960 ◽

Vol 26 (4) ◽

pp. 417-420 ◽

Cited By ~ 3

Author(s):

&NA;

Keyword(s):

Cleft Palate ◽

Flap Surgery ◽

Pharyngeal Flap

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The Intrajudge Reliability of the Perceptual Rating of Cleft Palate Speech Before and After Pharyngeal Flap Surgery: The Effect of Judges and Speech Samples

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569(1999)036<0328:tirotp>2.3.co;2 ◽

1999 ◽

Vol 36 (4) ◽

pp. 328-333 ◽

Cited By ~ 23

Author(s):

Kornelis H. D. Keuning ◽

George H. Wieneke ◽

Philippe H. Dejonckere

Keyword(s):

Cleft Palate ◽

Flap Surgery ◽

Cleft Palate Speech ◽

Before And After ◽

Pharyngeal Flap

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The Intrajudge Reliability of the Perceptual Rating of Cleft Palate Speech before and after Pharyngeal Flap Surgery: The Effect of Judges and Speech Samples

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1999_036_0328_tirotp_2.3.co_2 ◽

1999 ◽

Vol 36 (4) ◽

pp. 328-333 ◽

Cited By ~ 19

Author(s):

Kornelis H.D. Keuning ◽

George H. Wieneke ◽

Philippe H. Dejonckere

Keyword(s):

Cleft Palate ◽

Flap Surgery ◽

Cleft Palate Speech ◽

Before And After ◽

Pharyngeal Flap

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Comparison of Tongue Position during Speech before and after Pharyngeal Flap Surgery in Hypernasal Speakers

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1994_031_0280_cotpds_2.3.co_2 ◽

1994 ◽

Vol 31 (4) ◽

pp. 280-286 ◽

Cited By ~ 2

Author(s):

Keiji Tanimoto ◽

Gunilla Henningsson ◽

Annika Isberg ◽

Yan-Fang Ren

Keyword(s):

Cleft Palate ◽

Tongue Movement ◽

Flap Surgery ◽

Before And After ◽

Tongue Position ◽

Tongue Movements ◽

Pharyngeal Flap ◽

Almost All

Tongue position was cineradiographically analyzed during speech, before and after pharyngeal flap surgery, in 19 hypernasal cleft palate speakers with acceptable articulation and in 10 noncleft reference individuals. The results showed that the position of the tongue was significantly retracted during production of the consonants (/ti/, /ki/, and /ka/) in the cleft palate speakers with VPI compared to the reference individuals. Following pharyngeal flap surgery, the position of the tongue remained different in cleft palate speakers compared to reference Individuals, although the articulation quality and resonance were evaluated to have normalized in almost all the speech samples produced by cleft palate speakers. It was suggested that the cleft palate speakers with VPI may exploit the plasticity of the speech system in order to achieve perceptually good speech, even though their tongue movements might be different from tongue movement in noncleft speakers.

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