Important points for primary cleft palate repair for speech derived from speech outcome after three different types of palatoplasty

Funayama, Emi; Yamamoto, Yuhei; Nishizawa, Noriko; Mikoya, Tadashi; Okamoto, Toru; Imai, Satoko; Murao, Naoki; Furukawa, Hiroshi; Hayashi, Toshihiko; Oyama, Akihiko

doi:10.1016/j.ijporl.2014.09.021

Cited by 17 publications

(10 citation statements)

References 27 publications

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“…Concerning the outcome of primary palatoplasty, the success rate of 76% considering the speech outcomes is similar to findings reported in the international literature (19,20) and lower than others (21,22) , which reported proportions of 90% and 95%. Despite the relevant prevalence, the 24% of individuals with residual VPI will need additional treatment, which is a challenge for clinicians and surgeons.…”

Section: Discussionsupporting

confidence: 87%

Inteligibilidade de fala após palatoplastia primária: percepção do ouvinte

Andreoli

Yamashita

Trindade‐Suedam

et al. 2016

Audiol., Commun. Res.

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Purpose: To verify the results of speech intelligibility in individuals submitted to primary palatoplasty, according to perceptual analysis by five examiners, experienced or not with the treatment of cleft lip and palate. Methods: Analysis of spontaneous speech records, registered in audiovisual system, of 78 individuals with repaired cleft lip and palate, of both genders, aged more than 4 years old, submitted to primary palatoplasty. The speech samples were analyzed by five different examiners, who scored the speech intelligibility using a three-point scale (1=good, 2=regu-lar, and 3=bad). The interexaminer agreement was assessed by the Kappa coefficient. The treatment success was analyzed descriptively regarding the proportion of patients according to the postoperative speech intelligibility, as determined by the examiners. Significance between differences was verified by the chi-square test (p<0.05). Results: The interexaminer agreement ranged from fair to substantial. Full agreement between the five examiners was observed in more than half of cases. Based on the mean values assigned by the examiners, a significant proportion of cases showed good speech intelligibility after palatoplasty. Conclusion: The present outcomes evidenced adequate speech intelligibility after primary palatoplasty in the majority of cases, suggesting that these individuals are well understood in their social environment. The examiner experience presented to be an important variable in the analysis.Keywords: Cleft palate; Speech intelligibility; Speech perception; Velopharyngeal insufficiency; Reconstructive surgical procedures RESUMO Objetivo: Verificar os resultados de inteligibilidade da fala de pacientes submetidos à palatoplastia primária, de acordo com o julgamento perceptivo de cinco examinadores, experientes ou não, no tratamento de fissuras labiopalatinas. Métodos: Foram analisados os registros de fala espontânea, armazenados em sistema audiovisual, de 78 pacientes com fissura labiopalatina previamente reparada, de ambos os gêneros, a partir de 4 anos de idade, submetidos à palatoplastia primária. As amostras de fala foram analisadas por cinco diferentes examinadores, que classificaram a inteligibilidade de fala utilizando uma escala de 3 pontos (1=boa, 2=regular e 3=ruim). A concordância interexaminadores foi verificada por meio do coeficiente de Kappa. O sucesso da reabilitação foi analisado descritivamente quanto às proporções de pacientes, de acordo com o grau de inteligibilidade pós-operatória, determinada pelos examinadores. A significância entre as diferenças das proporções obtidas para cada categoria foi verificada pelo teste Qui-quadrado (p<0,05). Resultados: A concordância entre os examinadores variou de discreta a substancial. Em mais da metade das amostras os examinadores obtiveram concordância plena. Com base nos valores médios dos julgamentos dos avaliadores, uma proporção significativa dos casos apresentou boa inteligibilidade de fala. Conclusão: Verificou-se adequação da inteligibilidade de fala após a ...

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Section: Discussionsupporting

confidence: 87%

Inteligibilidade de fala após palatoplastia primária: percepção do ouvinte

Andreoli

Yamashita

Trindade‐Suedam

et al. 2016

Audiol., Commun. Res.

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“…Most eligible studies (91.3%) were published in the past 2 decades 4,6,7,12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Table 2). Most studies were conducted in Europe (43.5%) and 26.2% were conducted in the United States.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…There was no relevant difference in nasal emission. Funayama et al 24 performed a retrospective cohort study comparing 1-stage Furlow palatoplasty (group A) with 1-stage VWK pushback (group B) and 2-stage Furlow palatoplasty (group C) at 4 years of age. The results were in favor of the 1-stage Furlow palatoplasty and least beneficial for the 2-stage Furlow palatoplasty.…”

Section: Speechmentioning

confidence: 99%

“…41 Because this is the basis of later speech problems, it is important to know whether the technique used in primary cleft surgery plays a causal role. Five retrospective cohort studies investigated this issue 12,14,16,24,26,27,31 (Table 7). Doucet et al 31 described the beneficial effects of the Sommerlad IVVP compared with soft palate repair without IVVP.…”

Section: Velopharyngeal Functionmentioning

confidence: 99%

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Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review

Téblick

Ruymaekers

Casteele

et al. 2019

Journal of Oral and Maxillofacial Surgery

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Otitis media with effusion and disturbed speech are highly prevalent in children after cleft palate repair. Although many techniques for palatal closure have been described, no consensus has been reached on the most effective technique for these issues. The aim of this systematic review was to provide evidence-based information related to the effectiveness of different palatal closure techniques on middle ear and speech outcomes. Materials and Methods: A literature search in multiple electronic databases was performed: National Guidelines Clearinghouse, Trip Database, Cochrane Library, and Medline (PubMed). Potentially relevant articles were selected according to title and abstract and full-text eligibility. Then, quality control on the included articles was executed. Results: Twenty-three retrospective and prospective cohort studies were included in this systematic review. These studies compared at least 2 of the following techniques: von Langenbeck palatoplasty, 2-flap palatoplasty, Veau-Wardill-Kilner V-toY pushback technique, Kriens intravelar veloplasty, Sommerlad technique, Furlow double-opposing Z-plasties, and the Nadjmi modification of the Furlow palatoplasty. Their outcomes on the prevalence of otitis media with effusion, number of tympanostomy tubes placed, rates of hearing loss, and speech development were compared. Conclusions: The Sommerlad and Furlow palatoplasties were associated with the lowest prevalence of otitis media with effusion and the smallest number tympanostomy tubes needed. For hearing outcomes, the Furlow palatoplasty generated the best audiometric outcome. For speech outcomes, the Sommerlad and Furlow palatoplasties were more beneficial than the 2-flap palatoplasty, the Veau-Wardill-Kilner V-toY pushback technique, and the von Langenbeck palatoplasty. Additional randomized controlled trials are recommended to obtain evidence that can support these findings.

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“…Depending on the type of surgical procedure performed, the rate of fistula occurrence has been reported to be 4.9% (Bykowski et al, ) or up to 17.7% (Kahraman et al, ). These techniques range from the use of a pedicle buccal fat pad (BFP; de Castro, de Souza, & Fernandes Santos, ), conchal cartilage graft to repair large fistula (Funayama et al, ), multilayered repair of the whole palate (Funayama et al, ), or a tri‐layered repair where the bone and cartilage are harvested from the nasal septum of the same patient and are used to create the middle layer sandwiched between two vascular layers (Hudson & Pickett, ).…”

Section: Introductionmentioning

confidence: 99%

Developing a synthetic composite membrane for cleft palate repair

Sharif

Román

Asif

et al. 2019

J Tissue Eng Regen Med

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An oronasal fistula is a passage between the oral and nasal cavity. Currently, surgical procedures use mucosal flaps or collagen grafts to make a barrier between oral and nasal cavities. Our aim was to develop a cell-free synthetic repair material for closure of nasal fistulas. We surface functionalized electrospun polyurethane (PU) and poly-Llactic acid (PLLA) and composite polymer (PU-PLLA) membranes with acrylic acid through plasma polymerization. Membranes were treated in a layer-by-layer approach to develop highly charged electrostatic layer that could bind heparin as a pro-angiogenic glycosaminoglycan. The properties were evaluated through physical, chemical, and mechanical characterization techniques. Cytotoxicity was tested with MC3T3 pre-osteoblast cell lines for 3, 7, and 14 days, and vasculogenesis was assessed by implantation into the chorio-allantoic membrane in chick embryos for 7 days. In vivo biocompatibility was assessed by subcutaneous implantation in rats for 1, 3, and 6 weeks. The membranes consisted of random fibers of PLLA-PU with fiber diameters of 0.47 and 0.12 μm, respectively. Significantly higher cell proliferation and migration of MC3T3 cells at 3, 7, and 14 days were shown on plasmacoated membranes compared with uncoated membranes. Further, it was found that plasma-coated membranes were more angiogenic than controls. In vivo implantation of membranes in rats did not reveal any gross toxicity to the materials, and wound healing was comparable with the native tissue repair (sham group). We therefore present a plasma-functionalized electrospun composite polymer membrane for use in the treatment of fistulas. These membranes are flexible, non-cytotoxic, and angiogenic, and we hope it should lead to permanent closure of oronasal fistula.

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Important points for primary cleft palate repair for speech derived from speech outcome after three different types of palatoplasty

Cited by 17 publications

References 27 publications

Inteligibilidade de fala após palatoplastia primária: percepção do ouvinte

Inteligibilidade de fala após palatoplastia primária: percepção do ouvinte

Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review

Developing a synthetic composite membrane for cleft palate repair

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