Patient and surgical factors that affect the development of velopharyngeal insufficiency

Garland, Katie; Dworschak-Stokan, Anne; Matic, Damir B.

doi:10.1016/j.bjps.2022.06.036

Cited by 5 publications

(1 citation statement)

References 14 publications

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“…VPI can occur after the repair when the soft palate or velar muscle reconstruction is insufficient 77 , 78 . Patients with complete BCLP were associated with higher complication rates and poorer speech outcomes than other less severe cleft types 79 , 80 . The oronasal fistula was one of the common sequelae, and the incidence was reported to range from 5 to 60% 81 , 82 .…”

Section: Discussionmentioning

confidence: 91%

Long-term treatment outcome of patients with complete bilateral cleft lip and palate: a retrospective cohort study

Hattori

Pai

Saito

et al. 2023

International Journal of Surgery

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Background: Patients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reported in the literature. Patients and methods: A retrospective review was conducted on all patients with complete BCLP born between 1995 and 2002 and treated at our center. Inclusion criteria were having adequate medical records and receiving continuous multidisciplinary team care at least until 20 years of age. Exclusion criteria were lack of regular follow-up and congenital syndromic abnormalities. The medical records and photos were reviewed, and facial bone development was evaluated using cephalometric analysis. Results: A total of 122 patients were included, with a mean age of 22.1 years at the final evaluation in this study. Primary one-stage cheiloplasty was performed in 91.0% of the patients, and 9.0% underwent two-stage repair with an initial adhesion cheiloplasty. All patients underwent two-flap palatoplasty at an average of 12.3 months. Surgical intervention for velopharyngeal insufficiency was required in 59.0% of patients. Revisional lip/nose surgery was performed in 31.1% during growing age and in 64.8% after skeletal maturity. Orthognathic surgery was applied in 60.7% of patients with retruded midface, of which 97.3% underwent two-jaw surgery. The average number of operations to complete the treatment was 5.9 per patient. Conclusion: Patients with complete BCLP remain the most challenging group to treat among the cleft. This review revealed certain suboptimal results, and modifications have been made to the treatment protocol. Longitudinal follow-up and periodic assessment help to establish an ideal therapeutic strategy and improve overall cleft care.

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Section: Discussionmentioning

confidence: 91%

Long-term treatment outcome of patients with complete bilateral cleft lip and palate: a retrospective cohort study

Hattori

Pai

Saito

et al. 2023

International Journal of Surgery

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Tissue adjuncts in primary cleft palate reconstruction: A systematic review

Ku,

Al-Malak,

Mulvihill

et al. 2023

Journal of Plastic, Reconstructive & Aesthetic Surgery

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A Comparison of Postoperative Outcomes between Unilateral and Bilateral Palatoplasty: Analysis of 2015-2020 Pediatric NSQIP Data

Marquez,

Patel,

Scott

et al. 2023

The Cleft Palate Craniofacial Journal

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Objective We sought to identify differences in 30-day medical and surgical complications in unilateral versus bilateral palatoplasty. Design The NSQIP-P 2015-2020 database was queried to identify cleft palate repairs using CPT codes. Cases were stratified as unilateral (Veau III) and bilateral (Veau IV) using ICD-9 and −10 codes. Setting A nationally representative random sample. Patients/Participants A total of 3791 cases were identified with 2608 undergoing unilateral repair and 1183 undergoing bilateral repair. Main Outcomes/Measures The postoperative outcomes of interest included surgical complications (surgical site infections, wound dehiscence), medical complications (pneumonia, urinary tract infection, seizure, cardiac arrest, bleeding/transfusions, systemic sepsis, unplanned intubation), readmission, and reoperation. Results The bilateral cohort was older (696 days versus 619 days, P < .001) and had longer operative times (157.3 min versus 144.5 min, P < .001). The unilateral cohort had more comorbidities including developmental delay, structural CNS abnormalities, need for nutritional support, and bleeding disorders. The bilateral cohort had statistically significant higher occurrences of wound dehiscence (2.1% versus. 1.2%, P = .03) and readmission (3.2% versus 1.7%, P = .01). On multivariate analysis, bilateral cleft repair (OR: 1.83, CI: 1.176-2.840, P = .007) and ASA class 4 (OR: 13.1, CI 2.288- 62.586, P = .002) were associated with greater odds of readmission. Conclusion Patients who underwent bilateral cleft repair had a higher proportion of 30-day postoperative complications and a two-fold increased odds of readmission. While palatoplasty is generally regarded as a safe procedure in the pediatric population, identifying factors related to an increased risk of early postoperative complications can help surgical teams better manage high-risk individuals.

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Patient and surgical factors that affect the development of velopharyngeal insufficiency

Cited by 5 publications

References 14 publications

Long-term treatment outcome of patients with complete bilateral cleft lip and palate: a retrospective cohort study

Long-term treatment outcome of patients with complete bilateral cleft lip and palate: a retrospective cohort study

Tissue adjuncts in primary cleft palate reconstruction: A systematic review

A Comparison of Postoperative Outcomes between Unilateral and Bilateral Palatoplasty: Analysis of 2015-2020 Pediatric NSQIP Data

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