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.

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

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.

scholarly journals Adenoidectomy for middle ear disease in cleft palate children: a systematic review

2021 ◽  
Author(s):  
Cecilia Rosso ◽  
Antonio Mario Bulfamante ◽  
Carlotta Pipolo ◽  
Emanuela Fuccillo ◽  
Alberto Maccari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Acute Otitis Media ◽  
Case Series ◽  
Velopharyngeal Insufficiency ◽  
Middle Ear Disease ◽  
Conductive Hearing

Abstract Purpose Cleft palate children have a higher incidence of otitis media with effusion, more frequent recurrent acute otitis media episodes, and worse conductive hearing losses than non-cleft children. Nevertheless, data on adenoidectomy for middle ear disease in this patient group are scarce, since many feared worsening of velopharyngeal insufficiency after the procedure. This review aims at collecting the available evidence on this subject, to frame possible further areas of research and interventions. Methods A PRISMA-compliant systematic review was performed. Multiple databases were searched with criteria designed to include all studies focusing on the role of adenoidectomy in treating middle ear disease in cleft palate children. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for clinical indications and outcomes. Results Among 321 unique citations, 3 studies published between 1964 and 1972 (2 case series and a retrospective cohort study) were deemed eligible, with 136 treated patients. The outcomes were positive in all three articles in terms of conductive hearing loss improvement, recurrent otitis media episodes reduction, and effusive otitis media resolution. Conclusion Despite promising results, research on adenoidectomy in treating middle ear disease in the cleft population has stopped in the mid-Seventies. No data are, therefore, available on the role of modern conservative adenoidectomy techniques (endoscopic and/or partial) in this context. Prospective studies are required to define the role of adenoidectomy in cleft children, most interestingly in specific subgroups such as patients requiring re-tympanostomy, given their known risk of otologic sequelae.

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.

Comparison of Obstructive Sleep Apnea Syndrome in Children with Cleft Palate following Furlow Palatoplasty or Pharyngeal Flap for Velopharyngeal Insufficiency

2004 ◽  
Vol 41 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Yu-Fang Liao ◽  
M. Samuel Noordhoff ◽  
Chiung-Shing Huang ◽  
Philip K. T. Chen ◽  
Ning-Hung Chen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Velopharyngeal Insufficiency ◽  
Obstructive Sleep ◽  
The Mean ◽  
Pharyngeal Flap ◽  
Apnea Syndrome

Objective To evaluate the incidence and severity of obstructive sleep apnea syndrome (OSAS) in patients with cleft palate having a Furlow palatoplasty or pharyngeal flap for correction of velopharyngeal insufficiency (VPI). Patients A total of 48 nonsyndromic children with repaired cleft palate with VPI were enrolled in the study. Twenty of the children had a Furlow palatoplasty (F group) and 28 children had a pharyngeal flap (P group) for correction of VPI. Interventions An overnight polysomnography evaluation was done to evaluate the incidence and severity of OSAS 6 months or more postoperatively. Main Outcome Measures Symptoms of OSAS, respiratory disturbance index (RDI), oxyhemoglobin desaturation index (DI), and sleep stages were measured. Results In the P group, the mean percentage of stage 2 sleep was lower than the F group (p < .05). The mean RDI and DI were larger in the P group, compared with the F group (p < .001). The incidence and severity of OSAS were higher in the P group, compared with the F group (p < .001 and p = 0.05, respectively). Conclusions A Furlow palatoplasty should be used in deference to a pharyngeal flap whenever possible on the basis of the preoperative evaluation of VPI because of the decreased incidence and severity of OSAS.

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.

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