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.

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

1994 ◽  
Vol 31 (6) ◽  
pp. 452-460 ◽  
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.

RETROSPECTIVE STUDY OF MALARIA PREVALENCE IN SELECTED HOSPITALS IN ZARIA, NIGERIA

2021 ◽  
Vol 4 (4) ◽  
pp. 26-33
Author(s):  
Abdulhamid B. Ibrahim ◽  
E. Kogi
Keyword(s):  
Retrospective Study ◽  
Geographical Location ◽  
Malaria Prevalence ◽  
Demographic Variables ◽  
Main Campus ◽  
Record Keeping ◽  
Significant Difference ◽  
High Prevalence ◽  
Laboratory Record ◽  
Selection Of

A retrospective study of laboratory records in selected hospitals in Zaria was carried out to determine the trend of malaria prevalence between 2001 and 2005. Data was obtained from the following selected hospitals: St Luke’s Anglican Hospital, Wusasa, Salama Infirmary, Saidu Dange railway Hospital and Sick Bay, Ahmadu Bello University, Main campus, Samaru. The selection of the hospitals was based on their geographical location and sizes. The prevalence was consistently high over the years; 2001–44.1%, 2002–59.45%, 2003–59.35%, 2004–58.30% and 2005–64.25%. There was no significant difference (P>0.05) between malaria infection in males and females. Infection rates were significantly higher in children than adults (P<0.05) in all hospitals sampled except Salama Infirmary. Sick Bay in the main campus, Samaru had the least prevalence consistently over the five years period – 2001-27.0%, 2002-26.3%, 2003-21.8%, 2004-25.9% and 2005-33.2%. No clear seasonal variation over the years was observed. The study clearly showed consistent high prevalence over the five years period. Record keeping was useful as it provided data bur devoid of specific ages of attendees. Specific ages of hospital attendees rather than “children” or “adults” should be recorded and other demographic variables such as occupation and other socio-economic proxies should be included in laboratory record books

scholarly journals Comparison of the Effectiveness of Four Bariatric Surgery Procedures in Obese Patients with Type 2 Diabetes: A Retrospective Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Sylvie Pham ◽  
Antoine Gancel ◽  
Michel Scotte ◽  
Estelle Houivet ◽  
Emmanuel Huet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Retrospective Study ◽  
Cardiovascular Risk Factors ◽  
Surgical Procedures ◽  
Obese Patients ◽  
Significant Difference ◽  
Diabetic Population

Aim. The aim of the present retrospective study was to evaluate the efficacy of four bariatric surgical procedures to induce diabetes remission and lower cardiovascular risk factors in diabetic obese patients. Moreover, the influence of surgery on weight evolution in the diabetic population was compared with that observed in a nondiabetic matched population.Methods. Among 970 patients who were operated on in our center since 2001, 81 patients were identified as type 2 diabetes. Laparoscopic adjustable gastric banding (GB), intervention type Mason (MA), gastric bypass (RYGB), and sleeve gastrectomy (SG) were performed, respectively, in 25%, 17%, 28%, and 30% of this diabetic population.Results. The resolution rate of diabetes one year after surgery was significantly higher after SG than GB (62.5% versus 20%,P<0.01), but not significantly different between SG and RYGB. In terms of LDL-cholesterol reduction, RYGB was equivalent to SG and superior to CGMA or GB. Considering the other cardiovascular risk factors, there was no significant difference according to surgical procedures. The weight loss was not statistically different between diabetic and nondiabetic matched patients regardless of the surgical procedures used.Conclusion. Our data confirm that the efficacy of surgery to treat diabetes is variable among the diverse procedures and SG might be an interesting option in this context.

Carpal Instability Non-Dissociative

1994 ◽  
Vol 19 (6) ◽  
pp. 763-773 ◽  
Author(s):  
T. W. WRIGHT ◽  
J. H. DOBYNS ◽  
R. L. LINSCHEID ◽  
W. MACKSOUD ◽  
J. SIEGERT
Keyword(s):  
Retrospective Study ◽  
Soft Tissue ◽  
Surgical Management ◽  
Clinical Evidence ◽  
Wrist Pain ◽  
Carpal Instability ◽  
Soft Tissue Reconstruction ◽  
Results Of Treatment ◽  
Significant Difference ◽  
Tissue Reconstruction

A retrospective study of 45 patients with symptoms of wrist pain and weakness with clinical evidence of instability is presented. These patients had normal intrinsic interosseous ligaments demonstrated arthrographically or surgically. They were followed for a minimum of 18 months and an average of 5.8 years. All patients demonstrated instability of the proximal carpal row which is referred to as carpal instability non-dissociative (CIND). Seven patients were treated non-operatively and 38 were treated operatively. Surgical management consisted of soft tissue reconstruction directed at the area of instability in 34 cases, joint levelling osteotomy in six, three of whom also had soft tissue reconstructions, and mid-carpal fusion in one. The overall good and excellent results were a disappointing 56% and there was no significant difference between the non-surgical and surgical groups. The best results were found in the ulna-minus CIND patients who underwent a joint levelling osteotomy, with 83% good and excellent results. CIND is associatedwith extrinsic ligamentous laxity; however, significant difficulty exists in locating the precise areas of maximum pathology. This accounts for the unpredictable results of treatment. As our understanding of the pathomechanics of CIND improves, the treatment will become more specific and the results should improve.

Incidence of Cholesteatoma with Cleft Palate

1988 ◽  
Vol 97 (6) ◽  
pp. 659-660 ◽  
Author(s):  
Steven Dominguez ◽  
Lee A. Harker
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Cleft Palate ◽  
Interdisciplinary Team ◽  
Substantial Decrease ◽  
University Of Iowa ◽  
The University

The overall incidence of cholesteatoma in Iowa has been estimated to be 6.01/100,000 population, or less than 0.01 %. However, in patients with cleft palate seen at the University of Iowa Cleft Palate Clinic between 1947 and 1968 and followed for at least 10 years, the risk of developing cholesteatoma was 9.2%. In order to determine whether this high risk of cholesteatoma is still valid, a comparable retrospective study was undertaken of 153 patients with cleft palate who were born between 1969 and 1977, were enrolled in the University of Iowa Cleft Palate Clinic within 1 year of birth, and were followed by the interdisciplinary team for a minimum of 10 consecutive years. Cholesteatoma occurred in four patients (2.6%), a substantial decrease in the risk of developing cholesteatoma in a well-defined and longitudinally followed population.

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 Ligation of Intersphincteric Fistula Tract Is Suitable for Recurrent Anal Fistulas from Follow-Up of 16 Months

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Yansong Xu ◽  
Weizhong Tang
Keyword(s):  
Retrospective Study ◽  
Anal Fistula ◽  
Surgical Procedures ◽  
Medical Center ◽  
Fistula Tract ◽  
Anal Fistulas ◽  
Number Of Patients ◽  
Significant Difference ◽  
Intersphincteric Fistula

Since 2007, ligation of the intersphincteric fistula tract (LIFT) for the management of anal fistula was all introduced with initial success and excitement. It remains controversial which surgical procedure is suitable for transsphincteric fistula, especially to complex anal fistula. This retrospective study was designed to evaluate the results in patients with recurrent anal fistula by LIFT. A retrospective study of 55 complex fistula patients who underwent LIFT procedure in a single medical center was analyzed. Patients and fistula characteristics, complications, and recurrences were reviewed. All 55 patients underwent the procedure with a median follow-up of 16 months. Median operative time was 44 (range 23–88) minutes. Of the 55 patients, 33 (60%) healed completely and did not require any further surgical treatment at end of follow-up. Twenty-two (40%) recurrences and six complications were observed. Compared with patients who had undergone more than two surgical procedures, LIFT was more suitable for patients who had undergone one to two surgical procedures, and significant difference was observed in number of operations before LIFT (p=0.002). Clinicians can consider the use of LIFT for the treatment of recurrent anal fistulas. A larger number of patients and prospective study are needed to be performed.

Prescribing practices of antimicrobial prophylaxis in older patients in the surgical wards

2019 ◽  
Vol 1 (9) ◽  
pp. 446-453 ◽  
Author(s):  
Zakir Khan ◽  
Naveed Ahmed ◽  
Asim ur Rehman ◽  
Faiz Ullah Khan ◽  
Syed Muhammad Hamid
Keyword(s):  
Surgical Procedures ◽  
Older Patients ◽  
Antimicrobial Prophylaxis ◽  
Prescribing Practices ◽  
Elective Surgical Procedures ◽  
Appropriate Prescribing ◽  
Significant Difference ◽  
Optimal Value ◽  
Clean Contaminated ◽  
Selection Of

Background: appropriate prescribing of antimicrobial prophylaxis (AP) is a main strategy of the antimicrobial stewardship programme. Aim: to investigate the prescribing practices of antimicrobial prophylaxis and adherence to recommended protocols in older patients in the surgical wards at a 600-bed teaching hospital in Islamabad, Pakistan. Method: researchers selected 240 surgical procedures retrospectively for patients aged 65 years and older admitted to four surgical specialties (abdominal, orthopaedic, urological and neurosurgery) during 1 year. The different parameters of antimicrobial prescription were compared with international clinical practice guidelines. Findings: There were more ‘clean’ surgical wound procedures (n=104; 43.3%) than ‘clean contaminated’ (n=97; 40.4%) and most of these were elective surgical procedures (n=226; 94%). The indication, selection, route, dose, and timing of antimicrobial were found to have adhered with the standard guidelines in 89.6%, 32.5%, 100%, 100% and 55.3% of cases, respectively (optimal value 100%). A statistically significant difference was observed between antimicrobial practices and surgical procedures (P< 0.001). The commonly prescribed antimicrobials were ceftriaxone followed by cefazolin. Conclusion: about 89% of participants who underwent surgical procedures received antimicrobials. The selection of therapeutic agent, the timing and use of broad-spectrum antimicrobial were the common problems in our setting.

scholarly journals Characteristics and surgical outcomes of cleft palate in kabuki syndrome: a case series of 11 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jong-Ho Kim ◽  
Jiwon Kang ◽  
Joon Seok Oh ◽  
Taeseon Ahn ◽  
Baek-kyu Kim ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Surgical Outcomes ◽  
Case Series ◽  
Speech Development ◽  
Velopharyngeal Insufficiency ◽  
Flap Surgery ◽  
Number Of Patients ◽  
Significant Difference ◽  
Surgical Data ◽  
Pharyngeal Flap

Abstract Objective A significant number of patients with KS have cleft palate (CP) or submucous cleft palate (SMCP) and show delayed speech development. However, few reports have discussed the characteristics of CP in KS and the outcomes of postoperative speech development. The purpose of this study was to investigate the characteristics and surgical outcomes of CP in patients with KS, and to discuss the importance of the diagnosis of CP or SMCP. Methods We conducted a retrospective study on patients with clinically diagnosed KS who underwent palatoplasty. Clinical and surgical data were collected from patients’ medical records, and velopharyngeal function was evaluated using nasopharyngoscopy and speech analysis. Results In 11 cases, 5 patients had CP (45.5%) and 6 had SMCP (54.5%). Four patients who were genetically tested had a pathogenic variant of KMT2D. Seven of nine patients (77.8%) who underwent conventional palatoplasty showed velopharyngeal insufficiency and hypernasality. All patients who underwent pharyngeal flap surgery achieved velopharyngeal competency. Statistical analysis revealed a statistically significant difference in postoperative results between non-syndromic and KS patients. Conclusion Patients with SMCP may be more common than previously reported. The results showed that it is difficult to produce optimal results with conventional palatoplasty; therefore, pharyngeal flap surgery should be considered as a treatment to obtain favorable results. Pharyngeal flap surgery in patients with KS should be carefully designed based on speech evaluation and nasopharyngoscopic findings.

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