Superiorly based pharyngeal flap versus endoscopic augmentation of the posterior pharyngeal wall, using cartilage graft in the treatment of velopharyngeal insufficiency

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.

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Management of Speech and Swallowing Disorders in Children with Oral Clefts

10.2310/ps.10027 ◽

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

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Superiorly based pharyngeal flap and posterior pharyngeal wall augmentation

Operative Techniques in Otolaryngology-Head and Neck Surgery ◽

10.1016/j.otot.2009.10.012 ◽

2009 ◽

Vol 20 (4) ◽

pp. 268-273 ◽

Cited By ~ 3

Author(s):

J. Paul Willging

Keyword(s):

Posterior Pharyngeal Wall ◽

Pharyngeal Wall ◽

Pharyngeal Flap

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Autologous fat grafting in the treatment of velopharyngeal insufficiency: Clinical outcomes and treatment tolerability survey in a case series of 21 patients

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_183_17 ◽

2018 ◽

Vol 51 (02) ◽

pp. 145-154 ◽

Cited By ~ 2

Author(s):

Renzo Panizza ◽

Marco Ghiglione ◽

Enrico Maria Zingarelli ◽

Michela Massa ◽

Claudio Carlini ◽

...

Keyword(s):

Speech Therapy ◽

Treatment Protocol ◽

Specific Treatment ◽

Case Series ◽

Posterior Pharyngeal Wall ◽

Fat Grafting ◽

Small Sample ◽

Wilcoxon Test ◽

Velopharyngeal Insufficiency ◽

Pharyngeal Wall

ABSTRACT Introduction: Velopharyngeal insufficiency (VPI) is the inability to close the velopharyngeal sphincter during phonation and/or feeding. VPI is clinically characterised by hypernasal speech and nasal regurgitation. In cases of severe VPI, pharyngoplasty is recommended. Cases of mild-to-moderate VPI can be treated with fat grafting of the posterior pharyngeal wall in addition to speech therapy. The lipofilling can also be useful after pharyngoplasty to improve the outcomes. Materials and Methods: Twenty-one patients (14 males and 7 females), ages 4–23 affected by mild-to-moderate VPI and treated with lipofilling were included in this retrospective study. The mean injected fat volume was 7.95 cc (median 6 cc, min 4 cc, max 20 cc and range 16 cc). The follow-up ranged from 6 to 60 months. The pre- and post-operative Borel–Maisonny scores were compared using Wilcoxon test. Moreover, we performed a telephone survey with the aim to assess the parental perception on child's speech and quality of life after the surgical treatment. Results: Despite the small sample size, in this case series, we observed a statistically significant Borel–Maisonny score improvement and a parental satisfaction rate of about 85%. Conclusions: The augmentation of the posterior pharyngeal wall in addition to speech therapy improved the Borel–Maisonny score and the intelligibility of this case series of patients affected by mild-to-moderate VPI. In these patients, evaluated in a multidisciplinary approach, this technique allowed us to avoid major surgical procedures that would modify the anatomy of the velopharyngeal port. However, prospective comparative studies or randomised controlled trials could be useful to compare fat grafting with velopharyngoplasty techniques, with the aim to clarify indications and to define a specific treatment protocol.

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