Abstract
OBJECTIVES: To analyze the results of surgery for velopharyngeal incompetence (VPI) in velocardiofacial syndrome.
DESIGN: Prospective data collection, with randomized, blind assessment of speech and velopharyngeal function on lateral videofluoroscopy and nasendoscopy.
SETTING: Two-site, tertiary referral cleft unit.
PATIENTS: Forty-two consecutive patients with the 22q11 deletion underwent surgery for symptomatic VPI by a single surgeon.
INTERVENTIONS: Intraoral examinations, lateral videofluoroscopy (+/- nasendoscopy) and intraoperative evaluation of the position of the velar muscles through the operating microscope. Based on these findings, either a radical dissection and retropositioning of the velar muscles (submucous cleft palate [SMCP repair]) or a Hynes pharyngoplasty (posterior pharyngeal wall augmentation pharyngoplasty) was performed. As anticipated, a proportion of patients undergoing SMCP repair subsequently required a Hynes. The aim of this staged approach was to maximize velar function, thereby enabling a less obstructive pharyngoplasty to be performed. Thus, there were three surgical groups for analysis: SMCP alone, Hynes alone, and SMCP+Hynes.
MAIN OUTCOME MEASURES: Blind perceptual rating of resonance and nasal airflow; blind assessment of velopharyngeal function on lateral videofluoroscopy and nasendoscopy; and identification of predictive factors.
RESULTS: Significant improvement in hypernasality in all three groups. The SMCP+Hynes group also showed significant improvement in nasal emission. There were significant improvements in the extended and resting velar lengths following SMCP repair and a trend toward increased velocity of closure.
CONCLUSIONS: Depending on velopharyngeal anatomy and function, there is a role for SMCP repair, Hynes pharyngoplasty, and a staged combination of SMCP+Hynes, all of which are procedures with a low morbidity.
Original language | English |
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Pages (from-to) | 124-35 |
Number of pages | 12 |
Journal | Cleft Palate-Craniofacial Journal |
Volume | 41 |
Issue number | 2 |
DOIs | |
Publication status | Published - Mar 2004 |
Keywords / Materials (for Non-textual outputs)
- Adolescent
- Child
- Child, Preschool
- Chromosome Deletion
- Chromosomes, Human, Pair 22
- Cleft Palate
- Female
- Heart Defects, Congenital
- Humans
- Male
- Oral Surgical Procedures
- Palatal Muscles
- Pharynx
- Prospective Studies
- Random Allocation
- Single-Blind Method
- Speech Production Measurement
- Syndrome
- Velopharyngeal Insufficiency
- Video Recording
- Voice Disorders
- Clinical Trial
- Journal Article
- Randomized Controlled Trial
- Research Support, Non-U.S. Gov't