Internal Carotid Artery Variations in Velocardiofacial Syndrome Patients and Its Implications for Surgery

Baek, Rong Min; Koo, Youn Taek; Kim, Soo Jin; Kim, Ji Hoon; Kim, Ji Young; Kim, Baek Kyu

doi:10.1097/prs.0b013e3182a3c14b

Cited by 18 publications

(42 citation statements)

References 23 publications

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“…Furthermore, according to some authors, the autologous fat grafting can also be proposed to patients with aberrant courses of internal carotid arteries,[ 26 ] as can occur in the velocardiofacial syndrome. [ 27 ] As reported in the literature,[ 26 ] about 5% of the population has internal carotid arteries aberrant course.…”

Section: Discussionmentioning

confidence: 97%

Autologous fat grafting in the treatment of velopharyngeal insufficiency: Clinical outcomes and treatment tolerability survey in a case series of 21 patients

Panizza

Ghiglione

Zingarelli

et al. 2018

Indian J Plast Surg

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Introduction:Velopharyngeal insufficiency (VPI) is the inability to close the velopharyngeal sphincter during phonation and/or feeding. VPI is clinically characterised by hypernasal speech and nasal regurgitation. In cases of severe VPI, pharyngoplasty is recommended. Cases of mild-to-moderate VPI can be treated with fat grafting of the posterior pharyngeal wall in addition to speech therapy. The lipofilling can also be useful after pharyngoplasty to improve the outcomes.Materials and Methods:Twenty-one patients (14 males and 7 females), ages 4–23 affected by mild-to-moderate VPI and treated with lipofilling were included in this retrospective study. The mean injected fat volume was 7.95 cc (median 6 cc, min 4 cc, max 20 cc and range 16 cc). The follow-up ranged from 6 to 60 months. The pre- and post-operative Borel–Maisonny scores were compared using Wilcoxon test. Moreover, we performed a telephone survey with the aim to assess the parental perception on child's speech and quality of life after the surgical treatment.Results:Despite the small sample size, in this case series, we observed a statistically significant Borel–Maisonny score improvement and a parental satisfaction rate of about 85%.Conclusions:The augmentation of the posterior pharyngeal wall in addition to speech therapy improved the Borel–Maisonny score and the intelligibility of this case series of patients affected by mild-to-moderate VPI. In these patients, evaluated in a multidisciplinary approach, this technique allowed us to avoid major surgical procedures that would modify the anatomy of the velopharyngeal port. However, prospective comparative studies or randomised controlled trials could be useful to compare fat grafting with velopharyngoplasty techniques, with the aim to clarify indications and to define a specific treatment protocol.

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Section: Discussionmentioning

confidence: 97%

Autologous fat grafting in the treatment of velopharyngeal insufficiency: Clinical outcomes and treatment tolerability survey in a case series of 21 patients

Panizza

Ghiglione

Zingarelli

et al. 2018

Indian J Plast Surg

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“…Based on the results of the US survey and on his retrospective review of 39 patients with VCFS, 10 of which underwent surgery for the correction of VPD (5 sphincter pharyngoplasties and 5 pharyngeal flaps), Witt et al concluded that pharyngeal flaps and pharyngoplasties can be safely performed in patients with VCFS without preparatory angiography but acknowledged the study group (n ¼ 10) was small. With reference to the US surgeons' operative technique, around half of them perform a pharyngeal flap; which is a less popular choice among UK surgeons (Cable et al, 2004;Chegar et al, 2007;Baek et al, 2013). Baek et al (2013) reported in patients with VCFS the ICAs were found to be both more medially displaced and closer to the posterior pharyngeal wall (mean distance of 3.78 mm and closest distance of less than 1 mm; P < .05).…”

Section: Discussionmentioning

confidence: 99%

“…With reference to the US surgeons' operative technique, around half of them perform a pharyngeal flap; which is a less popular choice among UK surgeons (Cable et al, 2004;Chegar et al, 2007;Baek et al, 2013). Baek et al (2013) reported in patients with VCFS the ICAs were found to be both more medially displaced and closer to the posterior pharyngeal wall (mean distance of 3.78 mm and closest distance of less than 1 mm; P < .05).…”

Section: Discussionmentioning

confidence: 99%

“…Velocardiofacial syndrome (VCFS), also known as DiGeorge or 22q11 deletion syndrome, is characterized by facial anomalies, cleft palate (submucous or overt), velopharyngeal disproportion, congenital heart disease, and major vascular anomalies including abnormal placement of the internal carotid arteries (ICAs; Figure 1; Shprintzen, 2008). Many affected children present with velopharyngeal dysfunction (VPD) that can occur in the absence of an overt cleft and speech surgery is often necessary (Witt et al, 1998; Baek et al, 2013). Medial displacement of ICAs may increase the risk of significant vascular injury during the surgical correction of VPD; as such, accurate preoperative planning is crucial.…”

Section: Introductionmentioning

confidence: 99%

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Use of Preoperative Cervical Vascular Imaging in Patients With Velocardiofacial Syndrome and Velopharyngeal Dysfunction in the United Kingdom

Fallico

Timoney

Atherton

2020

The Cleft Palate-Craniofacial Journal

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Objective: In patients with velocardiofacial syndrome (VCFS), medial displacement of the internal carotid arteries (ICAs) may increase the risk of vascular injury during the surgical correction of velopharyngeal dysfunction (VPD). Some surgeons advocate the use of vascular imaging studies prior to surgery. Nevertheless, the role of preoperative imaging is still controversial. This study aimed to review the current practice of the UK cleft units and also examine our own practice at the Evelina London Children’s Hospital in relation to children with VCFS undergoing speech surgery over the previous 7 years. Design: A questionnaire was sent to all UK cleft surgeons to enquire about the management and use of preoperative vascular imaging in patients with VPD and VCFS. A retrospective study was also conducted of the unit’s 7-year series of patients with VPD and VCFS. Results: Thirty-four completed questionnaires were returned (response rate 100%). Most UK surgeons (73.5%) do not regularly order preoperative vascular imaging for patients with VCFS although some reportedly would consider it if a posterior pharyngeal wall pulsation was visible. In our unit, between 2013 and 2019, a total of 40 patients affected by VCFS have been assessed for VPD. A magnetic resonance angiography (MRA) was performed for 23 patients. Medial deviation of the ICAs was identified in 7 (30%) patients. Conclusions: The results of the national survey showed no consensus on routine use of preoperative vascular imaging. Our retrospective study showed a 30% prevalence of medialized ICAs in our patient cohort. In these patients, the MRA findings influenced the choice of speech surgery.

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“…The facial characteristics encountered are overfolding of the helix and cup ears, prominence of the nasal radix, narrow alar base and bulbous nose tip, fullness of the upper eyelids, malar flattening, elongated lower face height, retrognathia and facial asymmetry. 76 The course of the cervical part of the internal coronal artery was irrelevant, however, to the design of the pharyngeal flap and thus preoperative magnetic resonance angiography (MRA) was no longer recommended. 75 Many patients have a mild to moderate immune deficiency, and the majority have a cardiac anomaly.…”

Section: Bindermentioning

confidence: 99%

Craniofacial clefts

and

Versnel

2015

Plastic and Reconstructive Surgery

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Internal Carotid Artery Variations in Velocardiofacial Syndrome Patients and Its Implications for Surgery

Abstract: Risk, II.

Cited by 18 publications

References 23 publications

Autologous fat grafting in the treatment of velopharyngeal insufficiency: Clinical outcomes and treatment tolerability survey in a case series of 21 patients

Autologous fat grafting in the treatment of velopharyngeal insufficiency: Clinical outcomes and treatment tolerability survey in a case series of 21 patients

Use of Preoperative Cervical Vascular Imaging in Patients With Velocardiofacial Syndrome and Velopharyngeal Dysfunction in the United Kingdom

Craniofacial clefts

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