A Comparison of Speech Outcomes Using Radical Intravelar Veloplasty or Furlow Palatoplasty for the Treatment of Velopharyngeal Insufficiency Associated With Occult Submucous Cleft Palate

Abstract

Nonsyndromic patients with hypernasal speech are treated effectively and safely with either IVV or FP. Intravelar veloplasty trended toward lower speech scores than FP (76% IVV, 58% FP PWSS absolute reduction). Syndromic patients with OSMCP may be more effectively treated with FP (72% IVV vs 79% FP PWSS absolute reduction). Intravelar veloplasty is associated with shorter operative times. Both techniques are associated with low morbidity, improved speech scores, and low reoperative rates.

Speech and language characteristics in individuals with nonsyndromic submucous cleft palate—A systematic review

“…Phonology and language data reported in Schönweiler et al's () study were also excluded as they were grouped with other forms of orofacial clefting and not specific to SMCP. In two studies, nonsyndromic and syndromic cases were in the same experimental group; however, individual participant data were reported, enabling relevant nonsyndromic data to be extracted (Afrooz et al, ; Oji et al, ).…”

“…Evidence supporting the impact of surgery type on postoperative speech outcomes was mixed (Afrooz et al, ; Calis et al, ; Ezzat et al, ; Park et al, ). Afrooz et al () and Ezzat et al () reported no significant difference in postoperative velopharyngeal functioning between (a) radical intravelar veloplasty and modified Furlow palatoplasty; and (b) radical intravelar veloplasty and V–Y pushback pharyngoplasty with intravelar veloplasty, respectively. Park et al () found no significant difference in postoperative articulation between those who received a pushback palatoplasty, pharyngeal flap, pushback with pharyngeal flap, or Furlow palatoplasty.…”

“…Outcome data included hearing status, perceptual and instrumental (e.g., nasometry) speech measures, language abilities, and instrumental measures of velopharyngeal functioning (e.g., nasoendoscopy and videofluoroscopy). Finally, reviewers noted factors reported to impact speech and language outcomes in respective studies, for example: surgery type (Afrooz et al, 2015;Calis et al, 2018;Ezzat, El-Begermy, Eid, & Akel, 2016;Park et al, 2000), age at surgery (Baek et al, 2017;Bezuhly et al, 2012;Oji et al, 2013;Swanson et al, 2017) and preoperative speech characteristics (Baek et al, 2017;Bezuhly et al, 2012).…”

“…In two of these four studies, the nonsyndromic population acted as controls to the syndromic group (Bezuhly et al, 2012;Brandao et al, 2011). Remaining studies compared outcomes based on surgery (Afrooz et al, 2015;Ezzat et al, 2016;Park et al, 2000), cleft type (Park, Bae, Nam, Kang, & Sung, 2016;Schönweiler et al, 1999;Seagle et al, 2016) and age at surgery (Kwon et al, 2018;Swanson et al, 2017). Nine studies examined only nonsyndromic SMCP groups (Baek et al, 2017;Calis et al, 2018;Calnan, 1954;Isotalo et al, 2007;Kwon et al, 2018;Oji et al, 2013;Seagle, Patti, Williams, & Wood, 1999;Swanson et al, 2017; ten Dam et al, 2013).…”

Update on surgery for velopharyngeal dysfunction

“…Similarly, another recent retrospective review evaluated the safety and efficacy of radical intravelar veloplasty (group 1, 18 patients) versus Furlow palatoplasty (group 2, 17 patients) in the treatment of 35 patients with VPD and occult submucous cleft palate [16]. Patients were assigned on rotating schedule to either a surgeon who performed radical intravelar veloplasty or one who performed Furlow palatoplasty.…”