Buccinator Myomucosal Flap in Cleft Palate Repair: The SOBRAPAR Hospital Experience

Measuring Patient-Reported Health-Related Quality of Life in Velopharyngeal Insufficiency: Reliability and Validity of the Brazilian Portuguese Version of the VELO Instrument

“…In this study, we were thorough in including the degree of intra- and interevaluators agreement for hypernasality severity assessments. This methodology has been replicated both in VPI clinical practice and in subsequent outcome studies (Denadai et al, 2017; Denadai et al, 2018a; Denadai et al, 2018b; Denadai et al, 2018c; Mangilli and Sabbag, 2018; Denadai et al, 2019).…”

“…Patients were assessed using the multidisciplinary protocol of perceptual-auditory and instrumental evaluations of velopharyngeal function as previously reported (Denadai et al, 2017; Denadai et al, 2018a; Denadai et al, 2018b; Mangilli and Sabbag, 2018). All patients with repaired cleft palate were screened for VPI by the speech-language pathologist team using perceptual-auditory speech evaluation.…”

“…Nasal endoscopy was performed by a plastic surgeon with the speech-language pathology team in attendance. Speech and endoscopic recordings were rated at baseline and 2 weeks later by an independent panel of 3 evaluators (a plastic surgeon and 2 speech-language pathologists) with more than 10 years of experience in analyzing speech from patients with cleft palate based on previous reports (Sie et al, 2001; Deren et al, 2005; Perkins et al, 2005; Sie et al, 2008; Henningsson et al, 2008; Denadai et al, 2017; Denadai et al, 2018a; Denadai et al, 2018b). All parameters were tested using a phonetically balanced combination of single words, counting, and sentences that was read by the speech therapist and repeated by the patients in Brazilian Portuguese.…”

“…Perceptual ratings of speech recordings included hypernasality (none, mild, moderate, or severe), audible nasal air emission (none, mild, moderate, or severe), and intraoral pressure (normal or decreased; Sie et al, 2001; Deren et al, 2005; Perkins et al, 2005; Henningsson et al, 2008; Denadai et al, 2017; Denadai et al, 2018a; Denadai et al, 2018b). The velopharyngeal gap size during maximal closure on phonation (produce sustained “s” sounds) was rated as complete velopharyngeal closure, pinhole (demonstrated by mucus bubbling), small (velopharyngeal closure >80% and <100%), moderate (velopharyngeal closure between 50% and 80%), or large (velopharyngeal closure <50%; Sie et al, 2001; Deren et al, 2005; Perkins et al, 2005; Henningsson et al, 2008; Denadai et al, 2017; Denadai et al, 2018a; Denadai et al, 2018b). The 3 speech parameters (hypernasality, audible nasal air emission, and intraoral pressure) were combined to form the overall velopharyngeal competence that was graded as normal, borderline competent, borderline insufficient, or insufficient, as previously described (Sullivan et al, 2010; Wermker et al, 2014; Park et al, 2016; Denadai et al, 2017; Denadai et al, 2018a; Denadai et al, 2018b).…”

“…The velopharyngeal gap size during maximal closure on phonation (produce sustained “s” sounds) was rated as complete velopharyngeal closure, pinhole (demonstrated by mucus bubbling), small (velopharyngeal closure >80% and <100%), moderate (velopharyngeal closure between 50% and 80%), or large (velopharyngeal closure <50%; Sie et al, 2001; Deren et al, 2005; Perkins et al, 2005; Henningsson et al, 2008; Denadai et al, 2017; Denadai et al, 2018a; Denadai et al, 2018b). The 3 speech parameters (hypernasality, audible nasal air emission, and intraoral pressure) were combined to form the overall velopharyngeal competence that was graded as normal, borderline competent, borderline insufficient, or insufficient, as previously described (Sullivan et al, 2010; Wermker et al, 2014; Park et al, 2016; Denadai et al, 2017; Denadai et al, 2018a; Denadai et al, 2018b). Intrarater and interrater reliability of speech and endoscopy ratings were assessed using the intraclass correlation coefficient (ICC).…”