scholarly journals Nasoendoscopic findings after primary palatal surgery: can the Furlow technique result in a smaller velopharyngeal gap?

CoDAS ◽  
2015 ◽  
Vol 27 (4) ◽  
pp. 365-371 ◽  
Author(s):  
Gabriela Zuin Ferreira ◽  
Jeniffer de Cássia Rillo Dutka ◽  
Melina Evangelista Whitaker ◽  
Olivia Mesquita Vieira de Souza ◽  
Viviane Cristina de Castro Marino ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Cleft Palate ◽  
Soft Palate ◽  
Velopharyngeal Insufficiency ◽  
Speech Language Pathologists ◽  
The Difference ◽  
Definition Of ◽  
Palatal Surgery

PURPOSE: To compare the nasoendoscopic findings related to the velopharyngeal gap among patients with cleft palate who underwent the Furlow (F) technique and those who underwent the von Langenbeck (vL) technique for primary palatal surgery, who remained with velopharyngeal insufficiency (VPI).METHODS: The analyzed data were retrieved from the institution's data of recordings of nasoendoscopic exams. The sample comprised 70 recorded nasoendoscopic exams obtained from 22 patients who underwent the F technique and from 48 who underwent the vL technique during primary palatoplasty, who remained with VPI after surgery and were submitted to nasoendoscopy, between the ages of 5 and 15 years (mean age: 8 years), for definition of the best treatment for VPI. The images were edited into a DVD in a randomized sequence to be assessed by three experienced speech language pathologists regarding displacement and excursion of the soft palate; displacement and excursion of lateral pharyngeal's walls; displacement and excursion of the posterior pharyngeal's wall; and presence of the Passavant ridge and size and type of velopharyngeal gap.RESULTS: The results of the comparison of measurements between F and vL groups were not statistically significant.CONCLUSION: The surgical technique used in primary palatoplasty was not relevant to determine the difference in the size of the velopharyngeal gap for patients who maintained VPI.

Morphologic Significance of Bifid Uvula

PEDIATRICS ◽  
1985 ◽  
Vol 75 (3) ◽  
pp. 553-561
Author(s):  
Robert J. Shprintzen ◽  
Richard H. Schwartz ◽  
Avron Daniller ◽  
Lynn Hoch
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Velopharyngeal Insufficiency ◽  
Pediatric Practice ◽  
Submucous Cleft Palate ◽  
Hypernasal Speech ◽  
Definition Of

Bifid uvula is often regarded as a marker for submucous cleft palate although this relationship has not been fully confirmed. The reason for the tacitly assumed connection between these two anomalies has, in part, been perpetuated by the generally accepted definition of submucous cleft palate as the triad of bifid uvula, notching of the hard palate, and muscular diastasis of the soft palate. Recently, investigations have provided evidence of more subtle manifestations of submucous cleft palate by the use of nasopharyngoscopic examination of the palate and pharynx. It has been determined that submucous cleft palate can occur even when a peroral examination shows an intact uvula. This finding places the "marker" relationship in question. In order to determine the frequency of association between bifid uvula and submucous clefting, a total ascertainment of children with bifid uvula from a suburban pediatric practice was examined nasopharyngoscopically. It was determined that in all but two cases, children with bifid uvula had some or all of the landmarks of submucous cleft palate. Several of the children were found to have velopharyngeal insufficiency and mildly hypernasal speech. This finding prompts caution in the recommendation of adenoidectomy in the presence of bifid uvula.

Current Practices and Controversies in Management of the Submucous Cleft Palate

2016 ◽  
Vol 1 (5) ◽  
pp. 59-69 ◽  
Author(s):  
Lynn Marty Grames ◽  
Kamlesh Patel
Keyword(s):  
Cleft Palate ◽  
Surgical Repair ◽  
Consensus Conference ◽  
Velopharyngeal Insufficiency ◽  
Specific Information ◽  
Methods Of Evaluation ◽  
Submucous Cleft Palate ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Definition Of

A review of the published literature on submucous cleft palate was conducted. Specific information sought included definition and prevalence of submucous cleft palate, indications for surgical intervention, ideal age for intervention, evaluation tools for submucous cleft palate, and whether or not surgical repair was indicated for treatment of velopharyngeal insufficiency, feeding issues, or ear disease associated with submucous cleft. The research revealed that there is no consistent definition of submucous cleft palate in the published literature, which renders comparison of treatments difficult. In addition, the literature lacks consensus on the indications for submucous cleft palate repair, the effect of repair on ancillary disorders that may exist, and the best methods of evaluation for submucous cleft palate. A consensus conference on the submucous cleft may be valuable in guiding treatment and research going forward.

Velopharyngeal Function in Nonsyndromic Cleft Palate: Relevance of Surgical Technique, Age at Repair, and Cleft Type

1998 ◽  
Vol 35 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Eileen M. Marrinan ◽  
Richard A. Labrie ◽  
John B. Mulliken
Keyword(s):  
Surgical Technique ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Velopharyngeal Insufficiency ◽  
Significant Variable ◽  
Muscle Complex ◽  
Cleft Lip Palate ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function ◽  
Repair Group

Objective The goal of this study was to determine the relative importance of surgical technique, age at repair, and cleft type for velopharyngeal function. Design This was a retrospective study of patients operated on by two surgeons using different techniques (von Langenbeck and Veau-Wardill-Kilner [VY]) at Children's Hospital, Boston, MA. Patients We included 228 patients who were at least 4 years of age at the time of review. Patients with identifiable syndromes, nonsyndromic Robin sequence, central nervous system disorders, communicatively significant hearing loss, and inadequate speech data were excluded. Main Outcome Measure Need for a pharyngeal flap was the measure of outcome. Results Pharyngeal flap was necessary in 14% of von Langenbeck and 15% of VY repaired patients. There was a significant linear association (p = .025) between age at repair and velopharyngeal insufficiency (VPI). Patients with an attached vomer, soft cleft palate (SCP), and unilateral cleft lip/palate (UCLP) had a 10% flap rate, whereas those with an unattached vomer, hard/soft cleft palate (HSCP), and bilateral cleft lip/palate (BCLP) had a 23% flap rate (p = .03). Age at repair was critical for the unattached-vomer group (p = .03) but was not statistically significant for the attached-vomer group (p = .52). Conclusions Surgical technique was not a significant variable either in aggregate or for the Veau types. Patients in the earliest repair group (8-10 months) were the least likely to require a pharyngeal flap. Early repair was more critical for HSCP and BCLP patients. There was no correlation between velopharyngeal insufficiency and Veau hierarchy. The attached vomer/levator muscle complex may be a more important predictor of surgical success than the anatomic extent of cleft.

Musculature of the Soft Palate: Clinico-anatomic Correlations and Therapeutic Implications in the Treatment of Cleft Palates

1997 ◽  
Vol 34 (3) ◽  
pp. 189-194
Author(s):  
Christian Vacher ◽  
Bernard Pavy ◽  
Jeffrey Ascherman
Keyword(s):  
Surgical Technique ◽  
Cleft Palate ◽  
Nasal Mucosa ◽  
Soft Palate ◽  
Hard Palate ◽  
Surgical Repair ◽  
Posterior Border ◽  
Therapeutic Implications ◽  
Sagittal Orientation

Objective Hypoptasia of the maxilla, often described as a classic sequela to surgical repair of the cleft palate, has been rare In our experience. We believe that our surgical technique, which includes dividing the nasal mucosa and the abnormal muscular insertions at the posterior border of the hard palate, is an important factor in preventing this sequela. Method We compared the anatomy of 12 normal palates in cadavers to the anatomy of cleft palates seen at operation and to the anatomy of one cleft palate in a fetus aged 34 weeks. Results In cleft palates, the muscular fibers have an abnormal sagittal orientation, inserting on the posterior border of the hard palate. Conclusion The division of both the nasal mucosa and these abnormal muscular insertions at the posterior border of the hard palate enables the surgeon to eliminate the abnormal posterior pull of these fibers on the maxilla.

Unilateral Absence of the Soft Palate: Case Report of Reconstruction with a Mucoperiosteal Island Flap

1993 ◽  
Vol 30 (5) ◽  
pp. 497-499 ◽  
Author(s):  
M. Emin Mavili ◽  
Tacettin Gucer ◽  
Yucel Erk
Keyword(s):  
Case Report ◽  
Cleft Palate ◽  
Soft Palate ◽  
Speech Quality ◽  
Island Flap ◽  
Velopharyngeal Insufficiency ◽  
Congenital Absence

Congenital absence of half of the soft palate Is a rare deformity. There is little in the literature about its definition and management. This article presents a case with velopharyngeal insufficiency caused by unilateral absence of the soft palate. The patient was treated with a modification of the mucoperiosteal Island flap, first designed by Millard, to provide nasal lining during pushback lengthening of a short cleft palate. The speech quality of the patient Improved noticeably after the operation. Although island flap has limited use in primary cleft palate surgery, It may be effective in reconstruction of soft palate defects, when standard pushback procedures are not adequate for solving the problem.

Speech Production of Preschoolers with Cleft Palate

2005 ◽  
Vol 42 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Mary A. Hardin-Jones ◽  
David L. Jones
Keyword(s):  
Cleft Palate ◽  
Significant Relationship ◽  
Speech Therapy ◽  
Velopharyngeal Insufficiency ◽  
Chi Square ◽  
Independent Variables ◽  
Number Of Children ◽  
Dependent Variables ◽  
The Relationship ◽  
Palatal Surgery

Objective The present investigation was conducted to examine the prevalence of preschoolers with cleft palate who require speech therapy, demonstrate significant nasalization of speech, and produce compensatory articulations. The relationship among these three dependent variables and the independent variables of cleft type and age of primary palatal surgery was also examined. Participants The participants included 212 preschoolers with repaired cleft palate aged 2 years 10 months to 5 years 6 months. Main Outcome Measures Chi-square analyses were performed to examine the relationship between two independent variables (cleft type and age of surgery) and three dependent variables (percentage of children requiring speech therapy, percentage demonstrating moderate to severe hypernasality and receiving secondary management for velopharyngeal insufficiency, and percentage producing glottal/pharyngeal substitutions). Results Sixty-eight percent of the children were enrolled in (or had previously received) speech therapy. Thirty-seven percent of the children demonstrated moderate-severe hypernasality or had received secondary surgical management for velopharyngeal insufficiency. Chi-square analyses revealed a significant relationship between cleft type and the number of children referred for speech therapy as well as the number of children with significant hypernasality. The analyses also revealed a significant relationship between age of palatal surgery and number of children with significant hypernasality. Conclusions Despite advances in surgical management and the advantages offered by team care, the majority of preschoolers with cleft palate continue to demonstrate delays in speech sound development that require direct speech therapy. An optimal treatment regimen for these children is one that includes primary palatal surgery no later than 13 months of age.

scholarly journals Incidence of Speech-Correcting Surgery in Children With Isolated Cleft Palate

2018 ◽  
Vol 55 (8) ◽  
pp. 1115-1121 ◽  
Author(s):  
Charlotta Gustafsson ◽  
Arja Heliövaara ◽  
Junnu Leikola ◽  
Jorma Rautio
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
University Hospital ◽  
Velopharyngeal Insufficiency ◽  
Fistula Repair ◽  
Repair Rate ◽  
Medical Chart Review ◽  
Before School ◽  
Long Term Observation ◽  
Isolated Cleft Palate

Objective: Speech-correcting surgeries (pharyngoplasty) are performed to correct velopharyngeal insufficiency (VPI). This study aimed to analyze the need for speech-correcting surgery in children with isolated cleft palate (ICP) and to determine differences among cleft extent, gender, and primary technique used. In addition, we assessed the timing and number of secondary procedures performed and the incidence of operated fistulas. Design: Retrospective medical chart review study from hospital archives and electronic records. Participants: These comprised the 423 consecutive nonsyndromic children (157 males and 266 females) with ICP treated at the Cleft Palate and Craniofacial Center of Helsinki University Hospital during 1990 to 2016. Results: The total incidence of VPI surgery was 33.3% and the fistula repair rate, 7.8%. Children with cleft of both the hard and soft palate (n = 300) had a VPI secondary surgery rate of 37.3% (fistula repair rate 10.7%), whereas children with only cleft of the soft palate (n = 123) had a corresponding rate of 23.6% (fistula repair rate 0.8%). Gender and primary palatoplasty technique were not considered significant factors in need for VPI surgery. The majority of VPI surgeries were performed before school age. One fifth of patients receiving speech-correcting surgery had more than one subsequent procedure. Conclusion: The need for speech-correcting surgery and fistula repair was related to the severity of the cleft. Although the majority of the corrective surgeries were done before the age of 7 years, a considerable number were performed at a later stage, necessitating long-term observation.

Morphological Characterization of the Levator Veli Palatini Muscle in Children Born with Cleft Palates

2001 ◽  
Vol 38 (5) ◽  
pp. 438-448 ◽  
Author(s):  
Rolf Lindman ◽  
Gunnar Paulin ◽  
Per S. Stål
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Surgical Repair ◽  
Fiber Type ◽  
Muscle Spindles ◽  
Morphological Characterization ◽  
Velopharyngeal Insufficiency ◽  
Normal Adult ◽  
Levator Veli Palatini

Objective: The aim of this study was to analyze, morphologically and biochemically, one of the soft palate muscles, the levator veli palatini (LVP), in children born with cleft palate. Subjects and Methods: Biopsies were obtained from nine male and three female infants in connection with the early surgical repair of the hard and soft palate. Samples from five adult normal LVP muscles were used for comparison. The muscle morphology, fiber type and myosin heavy chain (MyHC) compositions, capillary supply, and content of muscle spindles were analyzed with different enzyme-histochemical, immunohistochemical, and biochemical techniques. Results: Compared with the normal adult subjects, the LVP muscle from the infantile subjects with cleft had a smaller mean fiber diameter, a larger variability in fiber size and form, a higher proportion of type II fibers, a higher amount of fast MyHCs, and a lower density of capillaries. No muscle spindles were observed. Moreover, one-third of the biopsies from the infantile subjects with cleft LVP either lacked muscle tissue or contained only a small amount. Conclusions: The LVP muscle from children with cleft palate has a different morphology, compared with the normal adult muscle. The differences might be related to different stages in maturation of the muscles, changes in functional demands with growth and age, or a consequence of the cleft. The lack of contractile tissue in some of the cleft biopsies offers one possible explanation to a persistent postsurgical velopharyngeal insufficiency in some patients, despite a successful surgical repair.

Applying the ICF-CY to Specialist Speech-Language Pathologists’ Practice With Toddlers With Cleft Palate Speech

2020 ◽  
Vol 57 (9) ◽  
pp. 1105-1116 ◽  
Author(s):  
Anna Cronin ◽  
Sharynne McLeod ◽  
Sarah Verdon
Keyword(s):  
Young Children ◽  
Cleft Palate ◽  
Cleft Lip ◽  
The United States ◽  
Velopharyngeal Insufficiency ◽  
International Classification Of Functioning ◽  
Speech Language Pathologists ◽  
Cross Sectional ◽  
Cleft Palate Speech ◽  
Public Clinics

Objective: To evaluate how the practice of specialist speech-language pathologists (SLPs) working with young children with cleft palate ± cleft lip (CP±L) maps onto the International Classification of Functioning, Disability, and Health – Children and Youth version (ICF-CY) and consider the functionality of the categories of the ICF-CY for this specialist area of practice. Design: Cross-sectional, qualitative study. Setting: Semistructured face-to-face interviews were conducted with SLPs working in tertiary-level hospitals, universities, and public clinics. Participants: Six specialist SLPs with 17 to 39 years of experience working with young children with CP±L as researchers and clinicians in Australia, Brazil, Denmark, Ireland, New Zealand, and the United States. Main Outcome Measure(s): Specialists’ practices were captured using in-depth, semistructured interviews. Data collected were analyzed by directed content analysis applying the ICF-CY as a coding schema. Results: In total, 4077 data points were coded. Most mapped onto Body Structures (684, 16.8%), Body Functions (906, 22.2%), and Environmental Factors (1626, 39.9%) with less emphasis on Activities and Participation (560, 13.7%). A “best fit” approach was taken to topics that did not map exactly onto categories of the ICF-CY (eg, velopharyngeal insufficiency [VPI]); however, there was not always an ideally suitable category available. Conclusions: The current study revealed strengths and challenges in categorizing practice within the ICF-CY for children with CP±L, including collaboration with parents and significant others, specificity around speech, language, and articulation, and the different types of VPI. Therefore, future discussion around how best to use the framework with children with CP±L is needed.

Primary Palatal Surgery in Nonsyndromic Cleft Palate Children and Velopharyngeal Insufficiency Correction Outcomes

2021 ◽  
Vol 32 (2) ◽  
pp. 698-704
Author(s):  
Drina C. Carvajal Álvarez ◽  
Mirta M. Palomares-Aguilera ◽  
María B. Meneses Geldres ◽  
Carlos Villarroel Giugliano
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Palatal Surgery
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