Sequential Treatment of Speech Disorders in Velocardiofacial Syndrome Patients

Wang, Guomin; Wang, Ke; Chen, Þ Yang; Yang, Yusheng; Wu, Yi-lai; Jiang, Liping; Xu, Haiosng; Salyer, Kenneth E.

doi:10.1097/scs.0b013e3181b6cc9c

Cited by 14 publications

(11 citation statements)

References 12 publications

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“…In three studies resonance was not one of the postoperative outcome measures [49], [50], [51]. These eight studies could not be used to answer the main question of this review, namely, whether a particular surgical technique leads to a higher percentage of patients with normal resonance postoperatively.…”

Section: Resultsmentioning

confidence: 96%

In Search of the Optimal Surgical Treatment for Velopharyngeal Dysfunction in 22q11.2 Deletion Syndrome: A Systematic Review

Spruijt

ReijmanHinze²,

Hens

et al. 2012

PLoS ONE

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BackgroundPatients with the 22q11.2 deletion syndrome (22qDS) and velopharyngeal dysfunction (VPD) tend to have residual VPD following surgery. This systematic review seeks to determine whether a particular surgical procedure results in superior speech outcome or less morbidity.Methodology/ Principal FindingsA combined computerized and hand-search yielded 70 studies, of which 27 were deemed relevant for this review, reporting on a total of 525 patients with 22qDS and VPD undergoing surgery for VPD. All studies were levels 2c or 4 evidence. The methodological quality of these studies was assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias. Heterogeneous groups of patients were reported on in the studies. The surgical procedure was often tailored to findings on preoperative imaging. Overall, 50% of patients attained normal resonance, 48% attained normal nasal emissions scores, and 83% had understandable speech postoperatively. However, 5% became hyponasal, 1% had obstructive sleep apnea (OSA), and 17% required further surgery. There were no significant differences in speech outcome between patients who underwent a fat injection, Furlow or intravelar veloplasty, pharyngeal flap pharyngoplasty, Honig pharyngoplasty, or sphincter pharyngoplasty or Hynes procedures. There was a trend that a lower percentage of patients attained normal resonance after a fat injection or palatoplasty than after the more obstructive pharyngoplasties (11–18% versus 44–62%, p = 0.08). Only patients who underwent pharyngeal flaps or sphincter pharyngoplasties incurred OSA, yet this was not statistically significantly more often than after other procedures (p = 0.25). More patients who underwent a palatoplasty needed further surgery than those who underwent a pharyngoplasty (50% versus 7–13%, p = 0.03).Conclusions/ SignificanceIn the heterogeneous group of patients with 22qDS and VPD, a grade C recommendation can be made to minimize the morbidity of further surgery by choosing to perform a pharyngoplasty directly instead of only a palatoplasty.

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Section: Resultsmentioning

confidence: 96%

In Search of the Optimal Surgical Treatment for Velopharyngeal Dysfunction in 22q11.2 Deletion Syndrome: A Systematic Review

Spruijt

ReijmanHinze²,

Hens

et al. 2012

PLoS ONE

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“…[5,11,24]. Other techniques which usually show a favorable outcome in cases of NSCP, such a Furlow palatoplasty or a secondary minimal incision palatopharyngoplasty [5,24,28,29] do not seem to provide the same success rate in patients with VCFS.…”

Section: Discussionmentioning

confidence: 96%

Velopharyngeal valving during speech, in patients with velocardiofacial syndrome and patients with non-syndromic palatal clefts after surgical and speech pathology management

Ysunza¹,

Pamplona²,

Morales³

2011

International Journal of Pediatric Otorhinolaryngology

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“…The median duration was 6 years, once weekly, for 30 minutes per session. This is much longer than reports from another center where, following a pharyngoplasty, patients receive 20-30 minutes of SLT weekly for an average of 8 months (maximum, 25 months) [13]. Others have found that greater speech improvement was attained and maintained over a longer period when SLT was more frequent than once weekly [21].…”

Section: Discussionmentioning

confidence: 98%

“…One study showed improvement of speech with increasing age, which is perhaps a corollary of development [3], albeit delayed [1,6,12]. In studies including older patients, the speech outcome was not reported separately [4,8,13], preventing conclusions regarding the further course of speech problems. In a study with adults aged 18 years or older, 41% had VPD or hypernasal speech [9].…”

Section: Introductionmentioning

confidence: 99%

Self-Reported Speech Problems in Adolescents and Young Adults with 22q11.2 Deletion Syndrome: A Cross-Sectional Cohort Study

et al. 2014

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BackgroundSpeech problems are a common clinical feature of the 22q11.2 deletion syndrome. The objectives of this study were to inventory the speech history and current self-reported speech rating of adolescents and young adults, and examine the possible variables influencing the current speech ratings, including cleft palate, surgery, speech and language therapy, intelligence quotient, and age at assessment.MethodsIn this cross-sectional cohort study, 50 adolescents and young adults with the 22q11.2 deletion syndrome (ages, 12-26 years, 67% female) filled out questionnaires. A neuropsychologist administered an age-appropriate intelligence quotient test. The demographics, histories, and intelligence of patients with normal speech (speech rating=1) were compared to those of patients with different speech (speech rating>1).ResultsOf the 50 patients, a minority (26%) had a cleft palate, nearly half (46%) underwent a pharyngoplasty, and all (100%) had speech and language therapy. Poorer speech ratings were correlated with more years of speech and language therapy (Spearman's correlation= 0.418, P=0.004; 95% confidence interval, 0.145-0.632). Only 34% had normal speech ratings. The groups with normal and different speech were not significantly different with respect to the demographic variables; a history of cleft palate, surgery, or speech and language therapy; and the intelligence quotient.ConclusionsAll adolescents and young adults with the 22q11.2 deletion syndrome had undergone speech and language therapy, and nearly half of them underwent pharyngoplasty. Only 34% attained normal speech ratings. Those with poorer speech ratings had speech and language therapy for more years.

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Sequential Treatment of Speech Disorders in Velocardiofacial Syndrome Patients

Abstract: Hypernasality and reduced mobility in palate and pharyngeal structures of VCFS patients could be measured with Chinese speech intelligibility test and blowing tests. The pharyngeal flap surgery and the behavioral therapy are proved to be an effective protocol for VCFS.

Cited by 14 publications

References 12 publications

In Search of the Optimal Surgical Treatment for Velopharyngeal Dysfunction in 22q11.2 Deletion Syndrome: A Systematic Review

In Search of the Optimal Surgical Treatment for Velopharyngeal Dysfunction in 22q11.2 Deletion Syndrome: A Systematic Review

Velopharyngeal valving during speech, in patients with velocardiofacial syndrome and patients with non-syndromic palatal clefts after surgical and speech pathology management

Self-Reported Speech Problems in Adolescents and Young Adults with 22q11.2 Deletion Syndrome: A Cross-Sectional Cohort Study

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