Velocardiofacial syndrome patients may have comparable outcomes to nonsyndromic patients in selective surgical management of velopharyngeal insufficiency. In addition, the data demonstrate the efficacy of a single-stage combined procedure without increased morbidity.

Introduction. Controversy exists over whether tonsillectomy will affect speech in patients with known velopharyngeal insufficiency (VPI), particularly in those with cleft palate. Methods. All patients seen at the OHSU Doernbecher Children's Hospital VPI clinic between 1997 and 2010 with VPI who underwent tonsillectomy were reviewed. Speech parameters were assessed before and after tonsillectomy. Wilcoxon rank-sum testing was used to evaluate for significance. Results. A total of 46 patients with VPI underwent tonsillectomy during this period. Twenty-three had pre- and postoperative speech evaluation sufficient for analysis. The majority (87%) had a history of cleft palate. Indications for tonsillectomy included obstructive sleep apnea in 11 (48%) and staged tonsillectomy prior to pharyngoplasty in 10 (43%). There was no significant difference between pre- and postoperative speech intelligibility or velopharyngeal competency in this population. Conclusion. In this study, tonsillectomy in patients with VPI did not significantly alter speech intelligibility or velopharyngeal competence.

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The authors report the results of a 4-year project to influence speech and hearing outcomes, employing direct program-management strategies with both multidiscipline professionals and family members of children born with oral clefts. Early and continuing speech and hearing diagnosis (12–60 months), parent education as speech aides, timely professional speech habilitation, including use of temporary speech appliances, and early medical care for ears were used in seeking a goal of normal oral-nasal resonance balance, developmentally normal articulation 1 and normal hearing by age 5 for 90% of children with cleft palate ± cleft lip. The project involved 41 children. This resulted in normal oral-nasal resonance in 93% (38) of the group at age 5. Normal developmental articulation proposed by Sander for "customary production" was also achieved by 93% at age 5. Thirty-eight of the 41 subjects produced 14 of 15 test phonemes correctly. Of the 15 test phonemes, / r / was most frequently in error. Twenty-seven percent (11) failed to produce this phoneme sucessfully. Sander norms require that 66% (not 100%) of 5-year-olds correctly produce this phoneme in two positions. When oral-nasal resonance balance and articulation were combined in each child, those children who achieved both normal oral-nasal resonance balance and normal articulation (per age expectancy) amounted to 88% (36). During the project, 98% (40) had normal hearing in at least one ear at age 5. Language screened normally for the group, as well. Twenty-two percent (8) of the subjects wore temporary speech appliances during the project. The effect of associated anomalies/abnormalities in 15 of the 41 subjects is also reported.

Objective: The safe and reliable reconstruction of composite mandibulectomy defects is a topic of significant interest. Unfortunately, a well-established small-animal model of the segmental composite mandibulectomy does not exist. We describe a reliable animal model that can be utilized to study mandibular reconstruction techniques, including atuogenous bone grafts and biomaterials.Method: Prospective analysis of survival-operations in the rat model (4-month Sprague Dawley Rattusnorvegicus). A detailed, stepwise description of surgical technique and relevant intraoperative anatomy is presented, utilizing photographic and radiographic images. Postoperative management, early pitfalls, surgical complications and future applications are discussed.Results: A total of 72 operations were performed by a single individual between July and October 2010. Two intraoperative and seven postoperative complications were recognized. There were 4 orocutaneous fistulas, 1 abscess, and 1 seroma. There were 3 fatalities; deaths were attributed to anesthetic complications (2, intraoperative) and foreign-body aspiration (1, postoperative). Conclusion:The novel animal model described here, reliably replicates the en-bloc segmental mandibular defects seen in our patient population. It can be manipulated to achieve a wide variety of research objectives, including the evaluation of biomaterials and tissue engineering techniques. Method: A prospective study of 232 patients with cleft palate repair from April 1995 to March 2010 at a tertiary care institution. The cleft palate was measured (mm) and repaired with a Furlow or 2-flap palatoplasty. Outcome measurements include fistula rate and secondary velopharyngeal insufficiency (VPI) repair. Facial Plastic and Reconstructive SurgeryResults: Primary cleft palate repair was performed on 232 patients by Furlow palatoplasty (n = 96) or 2-flap palatoplasty (n = 136). Patients were subdivided into 4 groups based on width: Group A 1 to 5 mm (n = 57), Group B 6 to 10 mm (n = 38), Group C 11 to 15 mm (n = 72), Group D 16 to 30 mm (n = 4). Fistula rates increase as the width of the palatal cleft increases. Fistula rates are similar between the Furlow and the 2-flap palatoplasty for each palatal width, except for clefts greater than 16mm. Two-flap palatoplasty has a higher rate of velopharyngeal insufficiency for all groups of cleft patients.Conclusion: At our institution the Furlow and 2-flap methods of palatoplasty have similar fistula rates for all cleft widths; however the Furlow method has decreased risk for subsequent velopharyngeal insufficiency compared with the 2-flap method. These data should encourage performance of the Furlow palatoplasty whenever feasible. Results: Eighty-seven cases involving the Double-Doyle intranasal airway splint technique performed for closed nasal reduction, selected cases of open rhinoplasty, and septal procedures revealed overall that this intranasal splint modification was safe, tolerated well by patients, and presented minimal morbidity. All but one patient expe...