Surgical Outcomes for Velopharyngeal Insufficiency in Velocardiofacial Syndrome and Non-syndromic Patients

Milczuk, Henry A.; Smith, Dana; Brockman, Janet H.

doi:10.1597/05-136

Cited by 2 publications

(6 citation statements)

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“…Hypernasal speech is a hallmark of VCFS [1] , resulting from a variety of anomalies including cleft palate, submucous cleft palate, palatopharyngeal hypotonia, deep retropharynx, or anterior positioning of the levator palatini [1,4,5] . While hypernasality is often eliminated in patients with nonsyndromic cleft palate with traditional surgical approaches, speech outcomes in the VCFS population have been less than optimal [6][7][8] . Losken et al [8] found that children with VCFS with a larger VP orifice ( 1 30 mm 2 ) were more likely to require additional surgery to reduce hypernasality.…”

Section: Introductionmentioning

confidence: 99%

Structural and Functional Causes of Hypernasality in Velocardiofacial Syndrome

Baylis

Watson

Moller

2009

Folia Phoniatr Logop

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Objective: Hypernasality in velocardiofacial syndrome (VCFS) is more severe, persistent, and difficult to manage compared to other populations with cleft palate or velopharyngeal (VP) dysfunction. This pilot study investigated why children with VCFS have more severe hypernasality. Methods: Pressure-flow methodology indirectly measured VP orifice size and VP closure timing during speech in a group of 5 children with VCFS, 5 children with cleft palate, and 6 normal children. Results: Children with VCFS demonstrated significant differences in VP closure timing and hypernasality. There were no significant group differences in VP orifice size. Duration of nasal airflow was the strongest predictor of judgments of hypernasality. Conclusion: This study provides preliminary evidence that VP closure timing may account for the more severe hypernasality in children with VCFS, compared to structural factors alone.

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Section: Introductionmentioning

confidence: 99%

Structural and Functional Causes of Hypernasality in Velocardiofacial Syndrome

Baylis

Watson

Moller

2009

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“…The only statistically significant difference recorded for patients with noncleft VPD is hypernasality. This study’s aim was not to compare the 2 groups, however this lower success rate is noted in previous studies involving patients with 22q11DS (Milczuk et al, 2007; Spruijt et al, 2012). This could be accounted for by the complex speech disorders noted in this population which can compromise motor speech disorders and neurological etiologies in addition to structurally based VPD.…”

Section: Discussionmentioning

confidence: 98%

“…The review reports “a variety of perceptual speech assessment scales” being used and the need for a “standardised minimum dataset to record pre and post-operative speech” (De Blacam et al, 2018, p. 420). The majority of manuscripts in this review reported perceptual speech outcomes using unvalidated 3- to 7-point scales (eg, Riski et al, 1992; Milczuk et al, 2007; Widdershoven et al, 2008; Filip et al, 2013), with only 5 of 83 manuscripts using a published, validated scale (Mehendale et al, 2004; Nayar et al, 2014; Boneti et al, 2015; Ezzat et al, 2015; Setabutr et al, 2015. )…”

Section: Introductionmentioning

confidence: 99%

“…Surgical techniques in 3 of the aforementioned studies (Mehendale et al, 2004; Swanson et al, 2011; Widdershoven et al, 2012) did not include Orticochea pharyngoplasty and reported results after palatoplasty, Hynes pharyngoplasty, and pharyngeal flap surgeries. In only 3 of 27 studies was the SLT blinded to the surgical procedure (Mehendale et al, 2004; Milczuk et al, 2007; Baylis et al, 2008). Sprujit et al (2012) concluded “non-standardised reporting of speech scores impeded comparison of preoperative baseline characteristics and postoperative outcome and different definitions were used to indicate ‘improved speech.”…”

Section: Introductionmentioning

confidence: 99%

“…In addition to patients with 22q11DS, studies to examine speech outcome following surgical interventions in patients presenting with noncleft VPD of mixed etiologies are very limited (Sie et al, 1998; Milczuk et al, 2007; Rouillon et al, 2009; Golinko et al, 2015). Improvements in hypernasality/nasal emission were observed for 62% to 91% of patients treated in these 4 studies following a pharyngoplasty procedure (Hynes, midline pharyngeal flap, and sphincter pharyngoplasty).…”

Section: Introductionmentioning

confidence: 99%

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Speech Outcomes Following Orticochea Pharyngoplasty in Patients With History of Cleft Palate and Noncleft Velopharyngeal Dysfunction

Birch

Jordan

Ferguson

et al. 2021

The Cleft Palate-Craniofacial Journal

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Objective: To report speech outcomes following Orticochea pharyngoplasty in 43 patients with cleft palate and noncleft velopharyngeal dysfunction. Design: A retrospective surgical audit of patients undergoing Orticochea pharyngoplasty between 2004 and 2012, with speech as a primary outcome measure. Setting: Patients known to a regional UK cleft center. Methods: Forty-three patients underwent Orticochea pharyngoplasty by a single surgeon in a UK regional cleft center. Twenty-one patients had undergone a prior procedure for velopharyngeal dysfunction. Pre- and postoperative speech samples were assessed blindly using the Cleft Audit Protocol for Speech-Augmented by a specialist cleft speech and language therapist, external to the team. Speech samples were rated on the following parameters: hypernasality, hyponasality, audible nasal emission, nasal, turbulence, and passive cleft speech characteristics. Statistical differences in pre- and postoperative speech scores were tested using the Wilcoxon matched-pairs signed-ranks test. Inter- and intrareliability scores were calculated using weighted Cohen κ. Results: Whole group: A statistically significant difference in pre- and postoperative scores for hypernasality ( P < .001), hyponasality ( P < .05), nasal emission ( P < .01), and passive cleft speech characteristics ( P < .01) were reported. Patients with cleft diagnoses: A statistically significant difference in scores for hypernasality ( P < .001), nasal emission ( P < .01), and passive cleft speech characteristics ( P < .01) were reported for this group of patients. Patients with noncleft diagnoses: The only parameter to demonstrate a statistically significant difference was hypernasality ( P < .01) in this group. Conclusions: Orticochea pharyngoplasty is a successful surgical procedure in treating velopharyngeal dysfunction in both the cleft and noncleft populations.

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Surgical Outcomes for Velopharyngeal Insufficiency in Velocardiofacial Syndrome and Non-syndromic Patients

Cited by 2 publications

References 0 publications

Structural and Functional Causes of Hypernasality in Velocardiofacial Syndrome

Structural and Functional Causes of Hypernasality in Velocardiofacial Syndrome

Speech Outcomes Following Orticochea Pharyngoplasty in Patients With History of Cleft Palate and Noncleft Velopharyngeal Dysfunction

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