Salvaging the Failed Pharyngoplasty: Intervention Outcome

1998 ◽  
Vol 35 (5) ◽  
pp. 447-453 ◽  
Author(s):  
Peter D. Witt ◽  
Terry Myckatyn ◽  
Jeffrey L. Marsh
Keyword(s):  
Revisional Surgery ◽  
Care Center ◽  
Surgical Revision ◽  
Flap Failure ◽  
Velopharyngeal Closure ◽  
Cause Of Failure ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty ◽  
Definition Of ◽  
Velopharyngeal Function

Objective This paper reports on the rates of failure of operations (pharyngeal flap and sphincter pharyngoplasty) performed for management of velopharyngeal dysfunction, and outcome following their revision. Design Anatomic abnormalities associated with unacceptable vocal resonance and nasal air escape following pharyngeal flap and sphincter pharyngoplasty were critiqued. The results of primary pharyngeal flap were evaluated for 65 patients, and the results of primary sphincter pharyngoplasty were evaluated for 123 patients. All patients were treated for velopharyngeal dysfunction. The definition of surgical failure was based on persistent hypernasality and/or nasal turbulence on perceptual speech evaluation, and incomplete velopharyngeal closure on instrumental evaluation, at least 3 months postoperatively. Setting All patients were evaluated and managed at the Cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital, a tertiary cleft care center. Patients, Participants All patients had failed surgical management initially, either with pharyngeal flap or sphincter pharyngoplasty, and all underwent repeat preoperative and postoperative perceptual speech evaluations; real-time lateral phonation fluoroscopy including still reference views; and flexible nasendoscopy of the velopharynx using standard speech protocols. Interventions Revisional surgery for both procedures consisted of either tightening of the sphincter pharyngoplasty or pharyngeal flap port(s) or reinsertion of the sphincter pharyngoplasty or pharyngeal flaps following dehiscence. Main outcome Measures The main outcome measure was normalcy of velopharyngeal function, i.e., elimination of perceptual hypernasality and instrumental evidence of complete velopharyngeal closure. The rates of pharyngeal flap failure and sphincter pharyngoplasty failure were determined for those patients requiring surgical revision. Results Thirteen of 65 patients (20%) who underwent primary pharyngeal flap required revisional surgery. Of these 13 patients, eight were managed successfully with a single revisional operation. The remaining five patients (38%) continued to exhibit velopharyngeal dysfunction and underwent a second revision consisting of tightening or augmentation of the lateral ports. Speech results were satisfactory in all patients so treated; however, hyponasality with no other airway morbidity occurred in all five. Twenty of 123 patients (16%) who underwent primary sphincter pharyngoplasty required surgical revision. Of these 20 patients, 17 were managed successfully. For both procedures, the principal cause of failure was partial or complete flap dehiscence. Conclusions Rates of primary pharyngeal flap failure are roughly equivalent to rates of primary sphincter pharyngoplasty failure. Pharyngeal flap and sphincter pharyngoplasty failures can be salvaged with revisional surgery, which can provide a velopharyngeal mechanism capable of complete closure. Revisional surgery is usually associated with denasal speech.

Posterior Pharyngeal Flap and Sphincter Pharyngoplasty: The State of the Art

2000 ◽  
Vol 37 (2) ◽  
pp. 112-122 ◽  
Author(s):  
Gerald M. Sloan
Keyword(s):  
Surgical Management ◽  
State Of The Art ◽  
Velopharyngeal Insufficiency ◽  
Flap Surgery ◽  
Specific Choice ◽  
Obstructive Sleep ◽  
Velopharyngeal Closure ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty ◽  
The 19Th Century

Surgical management of velopharyngeal insufficiency by attachment of posterior pharyngeal flap or construction of sphincter pharyngoplasty is reviewed. Posterior pharyngeal flap surgery is well established, with a long history dating back to the 19th century. Flaps have been based superiorly, inferiorly, or laterally. There have been reports of airway obstruction and obstructive sleep apnea associated with posterior pharyngeal flap surgery. The concept of surgical creation of a dynamic sphincter pharyngoplasty to provide velopharyngeal closure was first introduced by Hynes in 1950. Hynes and others have proposed several subsequent anatomic modifications. Airway dysfunction has also been reported following sphincter pharyngoplasty, but may not be as frequent or severe as with posterior pharyngeal flap. While several studies have compared posterior pharyngeal flap and sphincter pharyngoplasty in terms of speech outcome or complications, there is not, as yet, a consensus regarding the specific choice of one versus the other for surgical management of velopharyngeal insufficiency.

Surgical Considerations and Choices in the Management of Velopharyngeal Dysfunction

2015 ◽  
Vol 25 (2) ◽  
pp. 54-65 ◽  
Author(s):  
John Jensen ◽  
Michael VanLue
Keyword(s):  
Surgical Technique ◽  
Cleft Palate ◽  
Comprehensive Evaluation ◽  
Surgical Techniques ◽  
Speech Language Pathologist ◽  
Imaging Results ◽  
History Of ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty ◽  
Velopharyngeal Function

Determining the type of secondary surgical management to treat velopharyngeal dysfunction requires the incorporation of surgical indications and principles to the perceptual, acoustic/airflow, and imaging results of a comprehensive evaluation by a speech-language pathologist. In addition, how the specific type of surgical technique (primary and/or secondary) may affect velopharyngeal function also should be considered. The purpose of this paper is to consider three standard techniques commonly employed in speech surgery—Pharyngeal Flap; Sphincter Pharyngoplasty; and Furlow Double Opposing Z-Plasty—and provide examples of the specific imaging parameters that support the choice of surgical technique. In addition, information is provided regarding the characteristics of different primary surgical techniques for cleft palate which can influence velopharyngeal closure, given that the most common cause of velopharyngeal dysfunction seen in the clinic is a patient with a history of repaired cleft palate.

scholarly journals Surgical outcome of pharyngeal flap surgery and intravelar veloplasty on the velopharyngeal function

CoDAS ◽  
2013 ◽  
Vol 25 (5) ◽  
pp. 451-455 ◽  
Author(s):  
Daniela Aparecida Barbosa ◽  
Rafaeli Higa Scarmagnani ◽  
Ana Paula Fukushiro ◽  
Inge Elly Kiemle Trindade ◽  
Renata Paciello Yamashita
Keyword(s):  
Surgical Treatment ◽  
Surgical Outcome ◽  
Velopharyngeal Insufficiency ◽  
Cutoff Score ◽  
Flap Surgery ◽  
Orifice Area ◽  
Velopharyngeal Closure ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function ◽  
Intravelar Veloplasty

PURPOSE: To investigate the postoperative outcomes of pharyngeal flap surgery (PF) and secondary palatoplasty with intravelar veloplasty (IV) in the velopharyngeal insufficiency management regarding nasalance scores and velopharyngeal area. METHODS: Seventy-eight patients with cleft palate±lips submitted to surgical treatment for velopharyngeal insufficiency, for 14 months on an average, were evaluated: 40 with PF and 38 with IV, of both genders, aged between 6 and 52 years old. Hypernasality was estimated by means of nasalance scores obtained by nasometry with a cutoff score of 27%. The measurement of velopharyngeal orifice area was provided by the pressure-flow technique and velopharyngeal closure was classified as: adequate (0.000-0.049 cm2), adequate/borderline (0.050-0.099 cm2), borderline/inadequate (0.100-0.199 cm2), and inadequate (≥0.200 cm2). RESULTS: Absence of hypernasality was observed in 70% of the cases and adequate velopharyngeal closure was observed in 80% of the cases, in the PF group. In the IV group, absence of hypernasality was observed in 34% and adequate velopharyngeal closure was observed in 50% of the patients. Statistically significant differences were obtained between the two techniques for both evaluations. CONCLUSION: PF was more efficient than the secondary palatoplasty with IV to reduce hypernasality and get adequate velopharyngeal closure.

scholarly journals SARS-COV-2 INFECTION IN PRIMARY CARE: A SINGLE-CENTERED, RETROSPECTIVE, OBSERVATIONAL STUDY

2021 ◽  
Author(s):  
Pilar Galicia ◽  
Juan Jose Gutierrez Cuevas ◽  
Fang Fang Chen Chen ◽  
Laura Santos Larregola ◽  
Alberto Manzanares Briega ◽  
...  
Keyword(s):  
Primary Care ◽  
Arterial Hypertension ◽  
Clinical Characteristics ◽  
Care Center ◽  
Case Definition ◽  
Living Conditions ◽  
Primary Care Center ◽  
Predictive Role ◽  
Definition Of

Purpose: to describe the clinical characteristics of patients with confirmed SARS-CoV-2 infection in primary care and to analyze the predictive role of different risk factors on prognosis, especially living conditions. Methods: Retrospective longitudinal observational retrospective study by reviewing medical records from a primary care center since March 1 to April 30, 2020. Case definition of confirmed SARS-CoV-2 infection, sociodemographic data, clinical characteristics, comorbidity and living conditions were collected. The statistical analysis consisted in description of the sample, comparison of prognosis groups and analysis of prognostic factors. Results. A sample of 70 patients with confirmed SARS-CoV-2 infection was obtained, with comorbidity mainly related to arterial hypertension, overweight/obesity, hypercholesterolemia, diabetes and chronic pulmonary pathology. Pneumonia was present in 66%. Exitus occurred in 14% of the sample. Factors associated with mortality were advanced age (84 vs 55; p<0.0001), arterial hypertension (78% vs 41%; p=0.040), asthma-COPD (56% vs 13%; p=0.008) and atrial fibrillation (56% vs 5%; p=0.001). Conclusions. The study reflects the clinical practice of a primary care center. This kind of studies are essential to strengthen and reorganize the Health System and to try to anticipate the medium- to long-term consequences of COVID-19 on global health.

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

Robin Sequence: Obstructive Sleep Apnea following Pharyngeal Flap

1997 ◽  
Vol 34 (3) ◽  
pp. 256-260 ◽  
Author(s):  
David L. Abramson ◽  
Eileen M. Marrinan ◽  
John B. Mulliken
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Robin Sequence ◽  
Obstructive Sleep ◽  
High Incidence ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function ◽  
Repair Group

Objective We reviewed 24 children with Robin sequence who underwent cleft palate repair. Method All patients were 5 years of age or older at the time of review, allowing for accurate assessment of speech in relation to velopharyngeal function. All infants had palatal closure between 9 and 14 months of age, either V-Y repair (n = 16) or von Langenbeck repair (n = 8). Results Only 1 of 16 children who had V-Y repair had borderline velopharyngeal dysfunction (VPD). For reasons that are unclear, in the von Langenbeck repair group, six of eight children had VPD, and four of six underwent pharyngeal flap. Three additional patients with nonsyndromic Robin sequence had palatoplasty and subsequent pharyngeal flap. Six of the combined total of seven children with nonsyndromic Robin sequence developed obstructive sleep apnea and required flap take-down. Conclusion Since conventional pharyngeal flap for VPD in nonsyndromic Robin sequence children resulted in a high incidence of obstructive sleep apnea, alternative management should be considered: modification of the standard pharyngeal flap, palatal lengthening (V-Y or double-opposing Z-plasty), or construction of a speech bulb.

Changes in Speech following Maxillary Distraction Osteogenesis

2001 ◽  
Vol 38 (3) ◽  
pp. 199-205 ◽  
Author(s):  
Thomas W. Guyette ◽  
John W. Polley ◽  
Alvaro Figueroa ◽  
Bonnie E. Smith
Keyword(s):  
Outcome Measures ◽  
Distraction Osteogenesis ◽  
Care Center ◽  
Velopharyngeal Insufficiency ◽  
Clinical Report ◽  
Health Care Center ◽  
Before And After ◽  
Velopharyngeal Function ◽  
Maxillary Distraction

Objective: The purpose of this study was to describe changes in articulation and velopharyngeal function following maxillary distraction osteogenesis. Design: This is a descriptive, post hoc clinical report comparing the performance of patients before and after maxillary distraction. The independent variable was maxillary distraction while the dependent variables were resonance, articulation errors, and velopharyngeal function. Setting: The data were collected at a tertiary health care center in Chicago. Patients: The data from pre- and postoperative evaluations of 18 maxillary distraction patients were used. Outcome Measures: The outcome measures were severity of hypernasality and hyponasality, velopharyngeal orifice size as estimated using the pressure-flow technique, and number and type of articulation errors. Results: At the long-term follow-up, 16.7% exhibited a significant increase in hypernasality. Seventy-five percent of patients with preoperative hyponasality experienced improved nasal resonance. Articulation improved in 67% of patients by the 1-year follow-up. Conclusions: In a predominately cleft palate population, the risk for velopharyngeal insufficiency following maxillary distraction is similar to the risk observed in Le Fort I maxillary advancement. Patients being considered for maxillary distraction surgery should receive pre- and postoperative speech evaluations and be counseled about risks for changes in their speech.

Objective, Noninvasive Evaluation of Velopharyngeal Function in Cleft and Noncleft Patients

1998 ◽  
Vol 35 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Martin Kunkel ◽  
Ulrich Wahlmann ◽  
Wilfried Wagner
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Noninvasive Evaluation ◽  
Control Group ◽  
Pharyngeal Muscles ◽  
Pharyngeal Flap ◽  
The Difference ◽  
Acoustic Pharyngometry ◽  
Velopharyngeal Function

Objective The purpose of this study was to investigate a new diagnostic method that provides an approach to noninvasive, objective measurement of velopharyngeal movement by acoustic determination of epipharyngeal volume changes with velopharyngeal muscle function. Design This was a case control study, using consecutive samples. Setting This study took place at the Cleft Palate Rehabilitation Center of the University of Mainz, Germany. Patients Subjects were 29 consecutive cleft lip and palate (CLP) patients and 31 controls (21 patients with dysgnathia and 10 healthy volunteers). Intervention A series of transnasal acoustic measurements (pressure wave: 55 dB for 2 milliseconds) of epipharyngeal volume were performed with the pharyngeal muscles relaxed in end-expiration and while the velopharyngeal orifice was closed, with the difference in volume representing maximal pharyngeal movement. Results Cleft palate patients yielded significantly lower values of velopharyngeal movement (6.5 cm3) than did the control group (8.0 cm3)(p < .05; Mann-Whitney U test). Overlapping ranges of values were measured for the C(L)P and control groups. The least mobility (4.75 cm3) was measured in patients who had undergone pharyngeal flap surgery. Different patterns of restriction were observed in patients with and without a pharyngeal flap. Conclusion Acoustic pharyngometry may provide access to noninvasive quantitative measurement of velopharyngeal movement and a better understanding of the pattern of movement in C(L)P-patients. We expect it to be a helpful tool in objectively monitoring the progress of logopedic therapy.

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