Velopharyngeal insufficiency treated with levator muscle repositioning and unilateral myomucosal buccinator flap

Logjes, Robrecht J. H.; Aardweg, Maaike T. A. van den; Blezer, Meike M.J.; Heul, Anne M.B. van der; Breugem, Corstiaan C.

doi:10.1016/j.jcms.2016.10.012

Cited by 28 publications

(19 citation statements)

References 20 publications

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“…A key finding of this study was that 3 types of surgical techniques are being employed under the label of palate re-repair: Furlow DOZ (Chen et al, 1994), radical IVVP (Sommerlad et al, 1994; Sommerlad et al, 2002), and radical IVVP with palatal lengthening via either buccal myomucosal flaps (Robertson et al, 2008; Logjes et al, 2017) or mucosal Z-plasty (Woo et al, 2014; Logjes et al, 2017). Among these 3 surgical techniques, the only significant difference in outcomes between them was that radical IVVP had a higher incidence of achieving no consistent nasal air emission compared to Furlow DOZ (92% vs 63%, P = .0081).…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Palate Re-Repair for Treating Velopharyngeal Insufficiency: A Systematic Review and Meta-Analysis

Kurnik

Weidler

Lien

et al. 2020

The Cleft Palate-Craniofacial Journal

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Background: Palate re-repair has been proposed as an effective treatment for velopharyngeal insufficiency (VPI) with a low risk of obstructive sleep apnea (OSA). The authors conducted a systematic review and meta-analysis to determine the proportion of patients achieving normal speech resonance following palate re-repair for VPI, the proportion developing OSA, and the criteria for patient selection that are associated with increased effectiveness. Methods: PubMed, Embase, and Scopus were searched from inception through April 2018 for English language articles evaluating palate re-repair for the treatment of VPI in patients with a repaired cleft palate. Inclusion criteria included reporting of hypernasality, nasal air emission, nasometry, additional VPI surgery, and/or OSA outcomes. Meta-analysis was conducted using random effects models. Risk of bias was assessed regarding criteria for patient selection, blinding of outcome assessors, and validity of speech assessment scale. Results: Eighteen studies met inclusion criteria. The incidence of achieving no consistent hypernasality follow palate re-repair was 61% (95% confidence interval [CI]: 44%-75%). The incidence of additional surgery for persistent VPI symptoms was 21% (95% CI: 12%-33%). The incidence of OSA was 28% (95% CI: 13%-49%). Criteria for selecting patients to undergo re-repair varied, with anterior/sagittal position of palatal muscles (33%) and small velopharyngeal gap (22%) being the most common. No specific patient selection criteria led to superior speech outcomes ( P = .6572). Conclusions: Palate re-repair achieves normal speech resonance in many but not all patients with VPI. Further research is needed to identify the specific examination and imaging findings that predict successful correction of VPI with re-repair.

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Section: Discussionmentioning

confidence: 99%

The Effectiveness of Palate Re-Repair for Treating Velopharyngeal Insufficiency: A Systematic Review and Meta-Analysis

Kurnik

Weidler

Lien

et al. 2020

The Cleft Palate-Craniofacial Journal

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“…Pharyngoplasty was performed with cranial-based pharyngeal flap. Combined operations encompass a modified Z-plasty in combination with a buccal flap [20].…”

Section: Surgical Interventionmentioning

confidence: 99%

Surgical management in submucous cleft palate patients

et al. 2021

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Objectives The submucous cleft palate (SMCP) is considered to be the most subtle type of cleft palate. Early detection is important to allow on time intervention by speech therapy and/or surgical repair before the children already develop compensatory speech mechanisms. The purpose of this study was to investigate at what time children with a SMCP present, to determine when children are operated, and to analyze the postoperative outcomes for in SMCP children. Patient and methods Medical records from 766 individuals registered in the cleft registry in the Wilhelmina’s Children’s’ Hospital, Utrecht, were retrospectively reviewed. Inclusion criteria were children diagnosed with SMCP. The following data were collected: age at diagnosis, physical examination, age at surgery, surgical technique, speech therapy pre- and post-surgery, otitis media, secondary cleft surgery, family history, syndromes, and other anomalies. Results In total, 56 SMCP children were identified. The mean age of diagnosis was 44.0 months (range 0–150, SD = 37.0). In 48 children (85.7%), surgical intervention was performed (Furlow plasty, intravelar veloplasty, pharyngoplasty, or Furlow combined with buccal flap). Conclusion This retrospective study reconfirms that SMCP often presents late, even in a country with a modern healthcare system and adequate follow-up of all newborns by the so-called youth doctors in “children’s healthcare centers” up to the age of 4 years old. Almost 86% of patients ultimately needed palate surgery when SMCP was suspected. Clinical relevance Any child presenting with repeated episodes of otitis media, nasal regurgitation, or speech difficulties should have prompt consideration for SMCP as diagnosis.

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“…The U‐shaped CP associated with RS is thought to be the sequelae of deficient mandible growth early in pregnancy, leading to persistent tongue elevation and mechanical obstruction of palatal shelf closure in the fetus. In contrast, the etiology of RS without CP is thought to be due to deficient mandibular growth occurring predominantly after palatal shelf closure, or less severe early deficiency that does not interfere with palate closure (Logjes et al, 2017). Therefore, it is reasonable to consider that there may be differences in etiology and outcomes between children with RS with and without CP.…”

Section: Introductionmentioning

confidence: 99%

“…Children with RS described in prior studies have been grouped into "syndromic" and "isolated" categories, but also sometimes into a third "unique" or "RS-plus" category to capture those without a recognizeable syndrome (e.g. Stickler syndrome), but with additional anomalies or medical or developmental concerns (Holder-Espinasse et al, 2001;Logjes et al, 2017;Smith & Senders, 2006). Stickler syndrome is caused by heterozygous pathogenic variants in one of 6 genes encoding collagen subunits and has been consistently identified as the most common syndromic diagnosis in the majority of RS cohort studies (Robin et al, 1993(Robin et al, -2021.…”

mentioning

confidence: 99%

Robin sequence without cleft palate: Genetic diagnoses and management implications

Weaver

Sullivan

Balow

et al. 2021

American J of Med Genetics Pt A

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Robin sequence (RS), the triad of micrognathia, glossoptosis, and airway obstruction, is a major cause of respiratory distress and feeding difficulties in neonates. Robin sequence can be associated with other medical or developmental comorbidities in ~50% of cases (“syndromic” RS). As well, RS is variably associated with cleft palate (CP). Previous studies have not investigated differences in clinical characteristics of children with RS based on presence or absence of CP. We retrospectively reviewed 175 children with RS and compared genetic diagnoses, medical and developmental comorbidities, severity of airway obstruction, and feeding outcomes between those with and without CP. Strikingly, 45 of 45 (100%) children with RS without CP were classified as syndromic due to presence of comorbidities unrelated to RS, while 83 of 130 (64%) children with RS with CP were classified as syndromic. Among 128 children with syndromic RS, there were no differences in severity of airway obstruction, surgical intervention rate or type, or feeding outcome at 12 months based on CP status. Our findings support the conclusion that the pathogenesis of RS without CP is distinct from RS with CP and more likely to cause additional medical or developmental problems. Alternatively, children with RS without CP and without additional anomalies present may be under recognized.

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Velopharyngeal insufficiency treated with levator muscle repositioning and unilateral myomucosal buccinator flap

Cited by 28 publications

References 20 publications

The Effectiveness of Palate Re-Repair for Treating Velopharyngeal Insufficiency: A Systematic Review and Meta-Analysis

The Effectiveness of Palate Re-Repair for Treating Velopharyngeal Insufficiency: A Systematic Review and Meta-Analysis

Surgical management in submucous cleft palate patients

Robin sequence without cleft palate: Genetic diagnoses and management implications

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