Velopharyngeal videofluoroscopy: Providing useful clinical information in the era of reduced dose radiation and safety

Ysunza, Pablo Antonio; Bloom, David C.; Chaiyasate, Kongkrit; Rontal, Matthew; VanHulle, Rachel; Shaheen, Kenneth; Gibson, Donald

doi:10.1016/j.ijporl.2016.08.006

Cited by 14 publications

(14 citation statements)

References 17 publications

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“…A study by Ysunza et al . 8 concluded that a combination of multiplanar videofluoroscopy and flexible nasopharyngoscopy is a highly reliable procedure for assessing velopharyngeal closure, and to surgically and successfully correct velopharyngeal insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Velopharyngeal insufficiency in patients without a cleft palate: important considerations for the ENT surgeon

et al. 2020

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BackgroundVelopharyngeal insufficiency is the inability to close the velopharyngeal port during speech and swallowing, leading to hypernasal speech and food regurgitation.ObjectiveThis study aimed to explore the aetiological factors contributing to the development of velopharyngeal insufficiency in a non-cleft paediatric population, especially following adenoidectomy.MethodsA retrospective case review was conducted of all children without a known cleft palate, born between 2000 and 2013, who were referred to a tertiary cleft centre with possible velopharyngeal insufficiency.ResultsThe data for 139 children diagnosed with velopharyngeal insufficiency following referral to the cleft centre were analysed. Thirteen patients developed the condition following adenoidectomy; only 3 of these 13 had a contributing aetiological factor.ConclusionVelopharyngeal insufficiency is a rare but significant complication of adenoidectomy. The majority of patients who developed velopharyngeal insufficiency following adenoidectomy did not have an identifiable predisposing factor. This has important implications for the consent process and when planning adenoidectomy.

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Section: Discussionmentioning

confidence: 99%

Velopharyngeal insufficiency in patients without a cleft palate: important considerations for the ENT surgeon

et al. 2020

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“…All these patients underwent further surgery for correcting residual VPI. The specific surgical procedure in each case was selected and performed according to findings of VNP and MPVF as previously reported [ 11 , 12 ]. It should be pointed out that patients with compensatory articulation (five patients) received speech pathology treatment before the imaging procedures until they were able to repeat the speech sample with adequate articulation placement.…”

Section: Methodsmentioning

confidence: 99%

“…All patients with syndromic subtotal palatal clefts were operated on by a pharyngeal flap which was customized according to imaging procedures (VNP and MPVF) as described previously [ 11 , 12 ]. PPS was used in all these cases.…”

Section: Methodsmentioning

confidence: 99%

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Palatal Protective Stents Prevent Oro-Nasal Fistulas after Surgery for Velopharyngeal Insufficiency: A Preliminary Report

et al. 2018

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Background: One of the potential complications of surgery for velopharyngeal insufficiency (VPI) is postoperative oral-nasal fistula (ONF). Reported rates vary from 0 to 60%. Several factors are on account of these disproportionate rates. Objective: The purpose of this study was to describe the use of a palatal protective stent (PPS) to preserve the VPI repair surgical site and to study its effectiveness for decreasing the incidence of postoperative ONF. Materials and Methods: A retrospective study was carried out. All patients undergoing surgery for VPI with complete preoperative and postoperative evaluations including at least one year follow up after surgery from 2012 to 2016 were studied. Some of the patients were operated on using a pre-molded palatal protective stent (PPS). Twenty-seven patients were included in the study group. Most of the patients underwent a customized pharyngeal flap according to findings of imaging procedures. The remaining cases underwent a Furlow palatoplasty. Twelve patients were operated on using PPS. Results: There were no surgical complications during the procedures. ONF was detected in four of the patients operated on without PPS. None of the patients undergoing surgery using PPS demonstrated ONF. All fistulas were located at the soft/hard palate junction. VPI was corrected in 92% of the cases. Conclusion: Although only a reduced number of cases were studied, these preliminary results suggest that using PPS during surgical procedures for correcting VPI is a safe and reliable tool for preventing ONF.

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“…11 Despite continued debate regarding the importance of pharyngeal flap design and orientation, outcomes have demonstrated that VPI correction is not a one-size-fits-all procedure. 7,[12][13][14] Improved outcomes emphasize the surgical customization that suits the individual patient's anatomic and functional pathology.…”

Section: Introductionmentioning

confidence: 99%

Treatment of VPI with Customized Pharyngeal Flaps: One Size Does Not Fit All

Boudiab

Peshel

Ibrahim

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Failure of complete closure of the velopharyngeal sphincter results in velopharyngeal insufficiency (VPI), which may severely interfere with speech. The pharyngeal flap remains a common procedure for correcting VPI. We aimed to study whether customization of pharyngeal flaps using a dynamic preprocedural assessment can result in successful outcomes in the surgical treatment of VPI, despite variations in surgical technique. Methods: This is a retrospective review of patients between the ages 4 and 18 years old with VPI who underwent surgical correction by one of four surgeons at our institution. All four surgeons used a superiorly based pharyngeal flap (SBPF) with slight variations in operative technique. All patients also received an evaluation by the speech and language pathologist that included nasometry, multiplanar videofluoroscopy, and flexible videonasopharyngoscopy. Individualized preoperative planning was performed based on the findings. Results: In total, 158 patients (92%) demonstrated overall successful correction of VPI, defined by a normal post-operative mean nasalance. Thirteen patients (8%) presented with resonance improvement but persistent abnormal mean nasalance. The most common causes of failed VPI correction were inferior migration and/or shrinking of the pharyngeal flap. There was a nonsignificant association between surgical technique and unsuccessful corrections. Conclusions: The optimal surgical approach for performing pharyngeal flaps to correct VPI is individualized, customizing the procedure based on preoperative imaging. This study demonstrates that despite variations in surgical techniques for performing SBPF, high rates of success can be achieved when adequate surgical planning is based on imaging findings.

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Velopharyngeal videofluoroscopy: Providing useful clinical information in the era of reduced dose radiation and safety

Cited by 14 publications

References 17 publications

Velopharyngeal insufficiency in patients without a cleft palate: important considerations for the ENT surgeon

Velopharyngeal insufficiency in patients without a cleft palate: important considerations for the ENT surgeon

Palatal Protective Stents Prevent Oro-Nasal Fistulas after Surgery for Velopharyngeal Insufficiency: A Preliminary Report

Treatment of VPI with Customized Pharyngeal Flaps: One Size Does Not Fit All

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