Surgery for Velopharyngeal Dysfunction

2017 ◽  
Vol 55 (3) ◽  
pp. 405-422 ◽  
Author(s):  
Catherine de Blacam ◽  
Susan Smith ◽  
David Orr
Keyword(s):  
Systematic Review ◽  
Posterior Pharyngeal Wall ◽  
University Teaching ◽  
Common Procedure ◽  
Data Set ◽  
Pharyngeal Wall ◽  
Obstructive Sleep ◽  
Patient Reported ◽  
Pharyngeal Flap ◽  
Speech Assessment

Objective: This systematic review sought to evaluate the consensus in the literature regarding the surgical management of VPD and to determine whether a particular procedure results in superior speech outcome or less morbidity Design: A systematic review was carried out according to PRISMA-P guidelines. Systematic review software was used to facilitate 3-stage screening and data extraction by 2 reviewers. Setting: University teaching hospital. Patients, Participants: Studies that reported perceptual speech assessment or obstructive sleep apnea (OSA) in patients who had undergone surgery for VPD were included in the review. Interventions: Four categories of surgery for VPD were examined—pharyngeal flap, sphincter pharyngoplasty, palatoplasty, and posterior pharyngeal wall augmentation. Main outcome measures: Perceptual speech assessment, need for further surgery, and occurrence of OSA were the outcomes of interest. Results: Eighty-three relevant studies were identified, comprising data on 4011 patients. Pharyngeal flap was the most common procedure (64% of patients). Overall, 70.7% of patients attained normal resonance and 65.3% attained normal nasal emission. There was no notable difference in speech outcomes, need for further surgery, or occurrence of OSA across the 4 categories of surgery examined. Heterogeneous groups of patients were reported upon and a variety of perceptual speech assessment scales were used. Conclusions: There is a lack of consensus in the literature to guide procedure selection for patients with VPD. The development of a standardized minimum data set to record postoperative speech, OSA, and patient-reported outcomes is required.

Management of Speech and Swallowing Disorders in Children with Oral Clefts

2019 ◽  
Author(s):  
Ravi K. Garg ◽  
Delora L Mount
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Treatment Options ◽  
Posterior Pharyngeal Wall ◽  
Diagnostic Tools ◽  
Pharyngeal Wall ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty

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

A systematic review of different treatment strategies for the squamous cell carcinoma of the posterior pharyngeal wall

2020 ◽  
Vol 277 (10) ◽  
pp. 2663-2672
Author(s):  
Armando De Virgilio ◽  
Elena Russo ◽  
Andrea Costantino ◽  
Luca Malvezzi ◽  
Giovanni Colombo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Treatment Strategies ◽  
Posterior Pharyngeal Wall ◽  
Pharyngeal Wall

Assessment of the New L Pharyngeal Flap for Velopharyngeal Insufficiency

2020 ◽  
pp. 105566562095015
Author(s):  
Mohammad Waheed El-Anwar ◽  
Ezzeddin Elsheikh ◽  
Mohamed Abdelmohsen Alnemr ◽  
Amal Saed Quriba ◽  
Elham Hassan ◽  
...  
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Speech Therapy ◽  
Velopharyngeal Insufficiency ◽  
Valve Closure ◽  
Speech Evaluation ◽  
Obstructive Sleep ◽  
Horizontal Part ◽  
Pharyngeal Flap ◽  
Speech Assessment

Objective: To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI). Methods: This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation. Results: Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported. Conclusion: The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication.

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.

scholarly journals Relation between grades of acquired nasopharyngeal stenosis and severity of obstructive sleep apnea symptoms

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Mohammad Waheed El-Anwar ◽  
Ehsan Hendawy ◽  
Mohamed Eesa
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Disease Process ◽  
Rare Condition ◽  
Posterior Pharyngeal Wall ◽  
Nasal Breathing ◽  
Cross Sectional ◽  
Pharyngeal Wall ◽  
Scar Contracture ◽  
Obstructive Sleep

Abstract Background Nasopharyngeal stenosis (NPS) is a rare condition defined as the obstruction of the communication between the oropharynx and nasopharynx owing to scar contracture of the soft palate, tonsillar pillars, and posterior pharyngeal wall. NPS could be primary (attributed to a disease process such as rhinoscleroma) or secondary caused by prior surgery. In this study, we discuss the clinical manifestation of the acquired nasopharyngeal stenosis (NPS) and to investigate if there is a relation between the grade of the acquired NPS and the severity of obstructive sleep apnea (OSA) and patients’ symptoms. So, this cross-sectional study was conducted on patients who had post-surgical NPS of different grades. Then, the severity of snoring ± OSA and VAS of symptoms in those patients was assessed in different grades of the NPS, and the results were also statistically compared. Results Within the included 22 patients, there were no statistical differences between grade 1 and in grade 2 as regards age (p = 0.0619) or sex (p = 0.21137). The mean AHI was significantly more (p = 0.004) in grade 2 NPS than grade 1 NPS. The VAS of difficult nasal breathing and dysphagia were significantly worse (p < 0.0001) in grade 2 NPS than in grade 1, while the VAS of snoring did not differ significantly (p = 0.3466) between grade 1 and grade 2 NPS. Conclusion Grade 2 NPS leads to significantly more severe AHI, dysphagia, and difficult nasal breathing than grade 1 NPS. But the difference in the grade of NPS did not cause differences in the snoring intensity.

scholarly journals 0882 Local Deformation Analysis of Lateral Cephalogram for Childhood OSA Classification

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A336-A336
Author(s):  
H M Yuen ◽  
H L Chan ◽  
C T Au ◽  
K C Chan ◽  
L M Lui ◽  
...  
Keyword(s):  
Hyoid Bone ◽  
Soft Tissues ◽  
Posterior Pharyngeal Wall ◽  
Local Deformation ◽  
Training Data ◽  
Cephalometric Analysis ◽  
Minimal Distance ◽  
Classification Models ◽  
Pharyngeal Wall ◽  
Obstructive Sleep

Abstract Introduction Craniofacial profile is one of the anatomical causes of obstructive sleep apnea (OSA). Cephalometry provides information on patients’ skeletal structures and soft tissues. Traditional cephalometric analysis focuses on linear distances, angles, ratios and area of specific variables. Its classification power is often disappointed. In this study, a novel approach to cephalometric analysis using local deformation information was carried out to assess its efficacy in OSA classification. Methods This study was a retrospective analysis based on 60 case-control pairs who were Chinese children recruited for sleep studies in the Prince of Wales Hospital, with accessible lateral cephalometry and polysomnography (PSG) data. Local deformation technique was adopted to derive 1215 deformations from 15 manual landmarking on each cephalogram. In addition, three linear distances (hyoid bone to mandibular plane, hyoid bone to posterior pharyngeal wall, and minimal distance between tongue base and posterior pharyngeal wall) were measured from each cephalogram. A total of 1218 information features were obtained per subject. Classification models were built with an equal ratio between OSA and non-OSA groups (defined by OAHI≥1 and OAHI&lt;1 respectively). Forty pairs were used as training data and twenty pairs were used as testing data. Results Three model settings which used all 1218 cephalometric features, 800 features, and 500 features were tested. The accuracy for the three settings were 67.5% (sensitivity: 70%, specificity: 65%), 87.5% (sensitivity: 90%, specificity: 85%), and 92.5% (sensitivity: 95%, specificity: 90%) respectively. Apart from the three distances, the 500 topmost discriminative features were predominantly landmarks around the nasal cavity. Conclusion A new approach to cephalometric analysis using local deformation information can provide additional details on each cephalogram, hence, achieving better classification. The classification models using 500 features yielded the highest accuracy among the three settings. This setting could benefit most from the comprehensive comparison while avoiding overfitting. Support -

scholarly journals Wide Variation in Methodology in Level I and II Studies on Cartilage Repair: A Systematic Review of Available Clinical Trials Comparing Patient Demographics, Treatment Means, and Outcomes Reporting

Cartilage ◽  
2018 ◽  
Vol 12 (1) ◽  
pp. 7-23 ◽  
Author(s):  
Bryan Michael Saltzman ◽  
Michael L. Redondo ◽  
Adam Beer ◽  
Eric J. Cotter ◽  
Rachel M. Frank ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Cartilage Repair ◽  
Patient Reported Outcome ◽  
Outcome Evaluation ◽  
Control Group ◽  
Control Groups ◽  
Common Procedure ◽  
Patient Reported ◽  
Level I

Background The management of complex cartilage pathology in young, otherwise healthy patients can be difficult. Purpose To determine the nature of the design, endpoints chosen, and rate at which the endpoints were met in published studies and ongoing clinical trials that investigate cartilage repair and restoration procedures. Study Design Systematic review. Methods A systematic review of the publicly available level I/II literature and of the publicly listed clinical trials regarding cartilage repair and restoration procedures for the knee was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Seventeen published studies and 52 clinical trials were included. Within the 17 published studies, the most common procedure studied was microfracture (MFX) + augmentation ( N = 5; 29.4%) and the most common comparison/control group was MFX ( N = 10; 58.8%). In total, 13 different cartilage procedure groups were evaluated. For published studies, the most common patient-reported outcome (PRO) measures assessed is the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale–Pain (VAS) ( N = 10 studies, 58.8% each, respectively). Overall, there are 10 different PROs used among the included studies. Ten studies demonstrate superiority, 5 demonstrate noninferiority, and 2 demonstrate inferiority to the comparison or control groups. For the clinical trials included, the most common procedure studied is MFX + augmentation ( N = 16; 30.8%). The most common PRO assessed is KOOS ( N = 36 trials; 69.2%), and overall there are 24 different PROs used among the included studies. Conclusions Recently published studies and clinical trials evaluate a variety of cartilage repair and restoration strategies for the knee, most commonly MFX + augmentation, at various time points of outcome evaluation, with KOOS and VAS scores being used most commonly. MFX remains the most common comparison group for these therapeutic investigations. Most studies demonstrate superiority versus comparison or control groups. Understanding the nature of published and ongoing clinical trials will be helpful in the investigation of emerging technologies required to navigate the regulatory process while studying a relatively narrow population of patients.

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