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Objective: The addition of a uvular flap (PFU) was hypothesized to improve outcomes over standard pharyngeal flap (PF) for correction of velopharyngeal dysfunction. We report differences in outcomes of PF vs PFU at our institution. Design: Retrospective cohort study. Setting: Tertiary children's hospital. Patients: Children who underwent PF or PFU with the three highest-volume surgeons at our institution in 2004-2017. Outcome measures: We examined differences in complications between groups, frequency and type of revision surgery, and speech-related measures including nasometry, pressure-flow testing (PFT) and perceptual speech analysis (PSA). Results: 160 patients were included, 41 PF and 119 PFU (including 18 with Hogan technique). Patients undergoing PFU were older (7.6 yr vs 6.0 yr; p = 0.037) and more likely to have cleft palate (63/119 vs 14/41; p = 0.047). There was no significant difference in complications. With PFU, a decrease in airspace contracting revision surgeries was noted, (4/119 vs 8/41; p = 0.002) which drove a reduction in revision surgery of all types (7/119 vs 13/41; p = 0.033). However, patients that did undergo revision surgery after PFU underwent more revision procedures (p = 0.032). PSA scores were found to be lower (less hypernasal) after PFU (p = 0.009) compared to PF. Objective speech measures had varying results, with nasometry demonstrating a significant difference between groups (p = 0.001), while PFT (p = 0.525) did not demonstrate a statistical difference. Conclusion: The use of a uvular lining flap in pharyngeal flap surgery may be associated with improved long term surgical outcomes, including both improvements in subjective and objective testing and a lower rate of revision surgery, without increased complications. [ABSTRACT FROM AUTHOR]

Introduction: Superiorly based pharyngeal flap is one of the most common surgical techniques described for surgical correction of velopharyngeal disorders. Being a technique-sensitive and owing to its associated complications, a simple technique has been introduced and compared with it. Aim: The aim was to compare the surgical results and the phoniatric outcome of the superiorly based pharyngeal flap versus the myomucosal resection and direct closure of the posterior pharyngeal wall. Patients and Method: One hundred patients of both sexes were classified into two groups. Group A patients included fifty patients who had velopharyngeal insufficiency (VPI) and were surgically corrected by the superiorly based pharyngeal flap. Group B patients included fifty patients who had VPI and were surgically corrected by myomucosal resection and direct closure of the posterior pharyngeal wall. Results: Postoperatively, 13% of Group A patients had open nasality Grade 4 as compared to 0% in Group B patients. Hyponasality and obstructive sleep apnea were not recorded in any case of Group B patients as compared with 10% of Group A patients. With regard to the postoperative velopharyngeal gap during speech, 18% of patients in Group A had velopharyngeal gap 3 mm, while 10% of patients in Group B had velopharyngeal gap 3 mm. Conclusion: Myomucosal resection and direct closure of the posterior pharyngeal wall is a simple reliable technique for the correction of velopharyngeal disorders.

Background: The pharyngeal flap (PF) is useful for reconstruction of soft palate defects, but effective arrangements of PF for various types of soft palate defects are controversial. Here, we classify three types of soft palate defects and discuss the arrangements of PF and their functional prognosis. Methods: Reconstruction was performed based on the classification of the defects. Clinical details were collected, and postoperative function was analyzed. Results: Eight patients were included in the study. The defect sizes ranged from 25 (width) × 40 (depth) to 40 × 60 mm. Six patients underwent pharyngeal flap reconstruction with free‐flap reconstruction, and two underwent pharyngeal flap reconstruction. The pharyngeal flap was harvested at the maximum width of the posterior pharyngeal wall, ranging from 25 to 40 mm in length. Eating and speaking functions were maintained in all patients. Conclusions: Good postoperative function can be maintained by narrowing the velopharyngeal space with a pharyngeal flap. [ABSTRACT FROM AUTHOR]

Objective: Approximately 30% of patients with a history of repaired cleft palate (CP) go on to suffer from velopharyngeal dysfunction (VPD). This study discusses the operative management of VPD and postoperative speech outcomes in a cohort of CP patients. Setting: An academic tertiary pediatric care center. Methods: Retrospective cohort study. Patients: Patients with history of repaired CP (Veau I-IV) who underwent operative management of VPD between January 1st, 2010 and December 31st, 2020. Operative modalities were posterior pharyngeal flap (PPF), sphincter pharyngoplasty (SPP), Furlow palate re-repair, and buccal myomucosal flap palate lengthening (PL). Outcome measures: The primary outcome measure is postoperative speech improvement evaluated by the Pittsburgh Weighted Speech Scale (PWSS). Results: 97 patients met inclusion criteria. 38 patients with previous straight-line primary palatoplasty underwent Furlow re-repair; these patients were significantly younger (7.62 vs 11.14, P <.001) and were more likely to have severe VPD per PWSS (OR 4.28, P <.01, 95% CI 1.46-12.56) when compared to VPD patients with previous Furlow repair. 21.1% of these patients required an additional non-revisional VPD procedure. The remaining patients underwent a non-revision procedure (26 PPF, 22 SPP, 11 PL); all experienced significant (P <.001 on paired t-test) reductions in PWSS total and subgroup VPD severity scores without difference in improvement between operation types. SPP was statistically associated with all-cause complication (OR 2.79, 95% CI 1.03-7.59, P <.05) and hyponasality (OR 3.27, 95% CI 1.112-9.630, P <.05). Conclusion: Furlow re-repair reduced need for additional VPD operations. Speech outcomes between non-revisional operations are comparable, but increased complications were seen in SPP. [ABSTRACT FROM AUTHOR]

Background: Submental intubation is an airway management technique wherein an endotracheal tube is guided through incisions in the floor of the mouth and the submental skin after normal orotracheal intubation. Case presentation: A 20‐year‐old man with a history of pharyngeal flap construction for a cleft palate was planned for orthognathic surgery. Preoperative nasopharyngoscopy showed that the space lateral to the flap was too narrow for nasotracheal intubation; then submental intubation was performed. No intra‐ or postoperative complications were observed. Conclusion: Submental intubation is a useful alternative to tracheotomy in patients with difficulty in nasotracheal intubation during surgeries requiring occlusal confirmation. [ABSTRACT FROM AUTHOR]

Objective: To present the design and methodology for an actively enrolling comparative effectiveness study of revision palatoplasty versus pharyngoplasty for the treatment of velopharyngeal insufficiency (VPI) Design: Prospective observational multicenter study Setting: Twelve hospitals across the United States and Canada Participants: Individuals who are 3–23 years of age with a history of repaired cleft palate and a diagnosis of VPI, with a total enrollment target of 528 participants Interventions: Revision palatoplasty and pharyngoplasty (either pharyngeal flap or sphincter pharyngoplasty), as selected for each participant by their treatment team Main Outcome Measure(s): The primary outcome is resolution of hypernasality, defined as the absence of consistent hypernasality as determined by blinded perceptual assessment of a standard speech sample recorded twelve months after surgery. The secondary outcome is incidence of new onset obstructive sleep apnea. Statistical analyses will use propensity score matching to control for demographics, medical history, preoperative severity of hypernasality, and preoperative imaging findings. Results: Study recruitment began February 2021. As of September 2022, 148 participants are enrolled, and 78 have undergone VPI surgery. Enrollment is projected to continue into 2025. Collection of postoperative evaluations should be completed by the end of 2026, with dissemination of results soon thereafter. Conclusions: Patients with VPI following cleft palate repair are being actively enrolled at sites across the US and Canada into a prospective observational study evaluating surgical outcomes. This study will be the largest and most comprehensive study of VPI surgery outcomes to date. [ABSTRACT FROM AUTHOR]

Background: This study reviews the surgical and functional outcomes of children diagnosed with a bilateral cleft lip and palate and treated by the same surgical team following specific surgical protocols 18 years after surgery and during the follow-up. Methods: Based on a single-center retrospective design, demographic and surgical data were gathered by the authors from international institutions. Most of the data were quantitative in nature, and descriptive statistical and non-parametric tests were employed for analysis. All children born with a bilateral cleft from 1982 to 2002 were considered. Children affected by a syndrome were excluded. Complications and speech results were the main items measured. Results: Thirty patients were selected; 73.3% were treated using the inverse Malek procedure, and 26.7% underwent a modified two-stage procedure. Seventy percent developed an oronasal fistula. An alveolar bone graft was performed in 83%, and 53.3% underwent Le Fort osteotomy. Thirty-six percent required a pharyngeal flap, with good speech results. The median number of times general anesthesia was used among all the interventions considered was 5.5 (4.25–6). Conclusions: This study presents the long-term results of using the inverse Malek procedure to treat children with a bilateral cleft lip and palate. It is shown that this is related to a high risk of developing a fistula, but has good long-term speech results. [ABSTRACT FROM AUTHOR]

Background: Pharyngeal flap (PF) is a commonly used surgical technique in the treatment of velopharyngeal insufficiency (VPI), but it still faces limitations that have not been overcome. The present study aims to objectively analyze the results of PF combined with velar muscle repair, which aims to transform the static structure of PF into a dynamic one, addressing one of its limitations. Patients and Methods: Patients were divided into two groups based on the surgical technique: Group 1: the traditional PF group and Group 2: PF with radical intravelar veloplasty (PF-RIVVP) group. Acoustic evaluation of the velopharyngeal unit (VFU) and nasality level was conducted using a nasometry device during the preoperative period and at 1-year postoperative follow-up. Direct anatomical evaluation of the VFU was performed using a flexible fiberoptic endoscope. Student's t-test and Chi-square test were used for statistical analysis. Results: The mean preoperative nasalance score was 56.5 ± 11.0 in Group 2 and 59.9 ± 10.3 in Group 1. The postoperative mean nasalance score was 29.2 ± 3.1 in Group 2 and 35.3 ± 3.1 in Group 1. Although no statistically significant difference was observed in the mean preoperative nasalance scores, a statistically significant difference was found in the postoperative scores (P < 0.001). Furthermore, nasopharyngoscopic evaluation revealed a superior velopharyngeal movement in Group 2. Conclusion: Through the objective evaluation techniques, the present study demonstrates that PF combined with velar muscle repair provides an enhanced velopharyngeal function in the treatment of VPI compared to the traditional technique.

Objective: Stickler Syndrome (SS) is an inherited collagenopathy characterized by heterogenous orofacial, ocular, auditory, and skeletal abnormalities. The orofacial manifestations are variable and some patients present with cleft palate and velopharyngeal insufficiency (VPI). The incidence of VPI in SS is poorly studied and no studies have compared the incidence of VPI between Type I (COL2A1) and Type II (COL11A1) SS. The objective of this study is to compare the incidence of VPI between SS subtypes and discuss the surgical techniques used to treat them. Design: Single-institution, retrospective chart review. Setting: Tertiary pediatric hospital. Patients/participants: Forty-three children were diagnosed with SS between January 2003 and December 2018. Genetic testing results, genetics notes, craniofacial clinic notes, and operative reports were reviewed. Patients without genetic testing or craniofacial/otolaryngologic evaluation were excluded. Thirty-one patients met criteria and were included. Main Outcome Measure: Primary outcome was VPI incidence. Results: There were 18 patients with Type I SS and 13 with Type II SS. Five (16%) patients had VPI, 2 (11%) with Type I SS compared to 3 (23%) with Type II SS (P >.05). All patients with VPI underwent surgery with either sphincter pharyngoplasty (3) or pharyngeal flap (2). Two patients with Type II SS underwent revision sphincter pharyngoplasty, with one conversion to pharyngeal flap. Conclusion: VPI is common for patients with SS. In this study, there was no significant difference in the incidence of VPI between SS subtypes. Future studies are needed to confirm these findings, which could be important for patient counseling and treatment planning. [ABSTRACT FROM AUTHOR]

Background: Pharyngeal flap (PF) is a commonly used surgical technique in the treatment of velopharyngeal insufficiency (VPI), but it still faces limitations that have not been overcome. The present study aims to objectively analyze the results of PF combined with velar muscle repair, which aimsto transform the static structure of PF into a dynamic one, addressing one of itslimitations. Patients and Methods: Patients were divided into two groups based on the surgical technique: Group 1: the traditional PF group and Group 2: PF with radical intravelar veloplasty (PF‑RIVVP) group. Acoustic evaluation of the velopharyngeal unit (VFU) and nasality level was conducted using a nasometry device during the preoperative period and at 1‑year postoperative follow‑up. Direct anatomical evaluation of the VFU was performed using a flexible fiberoptic endoscope. Student’s t‑test and Chi‑square test were used for statistical analysis. Results: The mean preoperative nasalance score was 56.5 ± 11.0 in Group 2 and 59.9 ± 10.3 in Group 1. The postoperative mean nasalance score was 29.2 ± 3.1 in Group 2 and 35.3 ± 3.1 in Group 1. Although no statistically significant difference was observed in the mean preoperative nasalance scores, a statistically significant difference wasfound in the postoperative scores(P < 0.001). Furthermore, nasopharyngoscopic evaluation revealed a superior velopharyngeal movement in Group 2. Conclusion: Through the objective evaluation techniques, the present study demonstrates that PF combined with velar muscle repair provides an enhanced velopharyngeal function in the treatment of VPI compared to the traditional technique. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the speech outcomes, reveal postoperative rates of obstructive sleep apnea, and characterize changes in the pharyngeal flap and velopharyngeal anatomy following pharyngeal flap surgery for velopharyngeal insufficiency. A retrospective chart was reviewed for patients with clefts who underwent pharyngeal flap surgery between November 2020 and November 2021. The data collected included age, gender, cleft palate type, age at pharyngeal flap surgery, postoperative complications, age and type of primary palatoplasty, preoperative and postoperative speech assessments, magnetic resonance imaging findings, and obstructive sleep apnea outcomes. The authors included 72 nonsyndromic patients who underwent pharyngeal flap surgery following cleft palate repair. The mean age at pharyngeal flap surgery was 10.6 ± 6.2 years. There was a significant improvement in the Pittsburgh Weighted Speech Score Hypernasality Component and the nasalance scores of oral syllables (p < 0.001). The obstructive sleep apnea rate after pharyngeal flap surgery was 6.9%. Compared to preoperatively, the velar angle was more acute (p < 0.001), the velar length was longer (p < 0.001), the distance of the velum tip to the posterior pharyngeal wall was shorter (p < 0.001), the size of velopharyngeal gap was narrower (p < 0.001), and the pharyngeal flap atrophied (p < 0.001) at 6 months postoperatively. The pharyngeal flap improved speech outcomes in patients with velopharyngeal insufficiency with a relatively low incidence of obstructive sleep apnea (6.9%). The velum is positioned more superiorly and posteriorly, and the size of the velopharyngeal gap is substantially reduced after pharyngeal flap surgery. In addition, the pharyngeal flap partially atrophied over time. [ABSTRACT FROM AUTHOR]

Background and Objectives : A national survey of cleft teams was undertaken to evaluate the current standard of care for patients with cleft lip and palate (CLP) in India as a part of Cleft Care India study. Design : This was a cross-sectional questionnaire-based study. Method : Cleft teams across India attending the 19th Annual Conference of the Indian Society of Cleft Lip and Palate were invited to complete the questionnaire. The questionnaire consisted of 18 questions that included demographics, institutional details, patient protocols, surgical technique, rehabilitation facilities, and accessibility. The data are descriptively reported. Results : A total of 112 centers completed the survey. Nongovernment organizations funded 87% of the cleft centers and 8% did not receive any funding. Only 39% of the centers had centralized cleft services providing multidisciplinary care. Speech therapy was provided either onsite or through referral at 90% of the centers, whereas audiology was provided only at 4% of centers. Feeding advice was routinely provided in 52% of centers. Millard technique was the most preferred technique for unilateral cleft lip repair (66%). The 2-flap technique (37%) and pharyngeal flap (48%) were the most common surgeries for cleft palate and pharyngoplasty, respectively. Although 54% of centers reported their patients to be interested in comprehensive care, 43% reported that their patients only wanted surgical correction. Conclusions : There is wide diversity in access to cleft care and clinical practices across centers in India. Further work is needed to evaluate the quality of care by assessing outcomes of centers treating patients with CLP. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this study was to evaluate speech outcomes following surgical intervention for velopharyngeal dysfunction (VPD). Perceptual speech outcome data were subsequently analyzed in conjunction with patient factors such as congenital abnormalities, presence of cleft lip and/or palate, and age of repair. We hope to aid in the eventual creation of treatment algorithms for VPD, allowing practitioners to tailor surgical technique selection to patient factors. Methods A retrospective analysis was performed for all patients who underwent surgical correction of VPD at London Health Sciences Centre between the years 2005 and 2018. Two hundred and two consecutive VPD patients (median age 10.6 years) were followed for an average of 20.2 months after having undergone a superiorly based pharyngeal flap (121), Furlow palatoplasty (72), or sphincteroplasty (9). Speech outcomes were measured via the American Cleft Palate-Craniofacial Association (ACPA) perceptual speech assessment, and MacKay-Kummer Simplified Nasometric Assessment Procedures Revised (SNAP-R) was used to measure nasalence. Comparisons of mean preoperative and postoperative outcomes were made, as well as analyses regarding surgical procedure, syndrome, cleft status, and age. Results Mean perceptual scores improved significantly postoperatively (p

Objective : Secondary procedures optimize outcomes following cleft lip and palate (CL/P) repair. We analyzed the association between race and the utilization and timing of revisionary/secondary cleft surgeries in the United States. Design : Primary CL/P repair, revisions, and secondary procedures—cleft rhinoplasty, speech surgery, and alveolar bone grafting (ABG)—performed from 2014–2018 were identified from the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Utilization estimates were derived via univariable and multivariable logistic regression. A Kruskal-Wallis rank-sum test and multivariable linear regression were used to assess differences in timing for each procedure cohort. Main Outcome Measures : The primary outcome measures were the odds of a patient being a certain race/ethnicity, and the age at which patients of different race/ethnicity receive surgery. Results : There were 23 780 procedures analyzed. After controlling for sex, diagnosis, and functional status, there were significant differences in utilization estimates across procedure groups. Primarily, utilization was lowest in patient who were Black for cleft rhinoplasty (OR = 0.70, P =.023), ABG (OR = 0.44, P <.001) and speech surgery (OR = 0.57, P =.012), and highest in patients who were Asian patients in all surgery cohorts (OR 2.05-4.43). Timing of surgery also varied by race, although differences were minimal. Conclusions: Estimates of utilization and timing of secondary cleft procedures varied by race, particularly among patients who were Black (poor utilization) or Asian (high utilization). Further studies should identify the causes and implications of underutilized and/or delayed cleft care. [ABSTRACT FROM AUTHOR]

Objective: The addition of a uvular flap (PFU) was hypothesized to improve outcomes over standard pharyngeal flap (PF) for correction of velopharyngeal dysfunction. We report differences in outcomes of PF vs PFU at our institution., Design: Retrospective cohort study., Setting: Tertiary children's hospital., Patients: Children who underwent PF or PFU with the three highest-volume surgeons at our institution in 2004-2017., Outcome Measures: We examined differences in complications between groups, frequency and type of revision surgery, and speech-related measures including nasometry, pressure-flow testing (PFT) and perceptual speech analysis (PSA)., Results: 160 patients were included, 41 PF and 119 PFU (including 18 with Hogan technique). Patients undergoing PFU were older (7.6 yr vs 6.0 yr; p  =  0.037) and more likely to have cleft palate (63/119 vs 14/41; p  =  0.047). There was no significant difference in complications. With PFU, a decrease in airspace contracting revision surgeries was noted, (4/119 vs 8/41; p  =  0.002) which drove a reduction in revision surgery of all types (7/119 vs 13/41; p  =  0.033). However, patients that did undergo revision surgery after PFU underwent more revision procedures (p  =  0.032). PSA scores were found to be lower (less hypernasal) after PFU (p  =  0.009) compared to PF. Objective speech measures had varying results, with nasometry demonstrating a significant difference between groups (p  =  0.001), while PFT (p  =  0.525) did not demonstrate a statistical difference., Conclusion: The use of a uvular lining flap in pharyngeal flap surgery may be associated with improved long term surgical outcomes, including both improvements in subjective and objective testing and a lower rate of revision surgery, without increased complications., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study evaluated the results of a reproductible protocol indicating the need for a pharyngeal flap in children with cleft palate and velopharyngeal insufficiency (VPI). A retrospective review of all patients operated for a pharyngeal flap between 2010 and 2019 in our center was conducted. After exclusion of patients with primary VPI or residual fistulas, 31 patients' data were analyzed. Our main outcome measure was the improvement of the Borel Maisonny Classification (BMC) by at least 1 rank. Further analysis was made to evaluate the impact of age, type of cleft, and BMC before surgery on the gain in the velopharyngeal function. Of the 31 patients, success was achieved in 29 (93.5%, p<0.005). There was no significant correlation between age and gain in the velopharyngeal function (p = 0.137). There was no significant correlation between type of cleft and gain in the velopharyngeal function (p = 0.148). There was a significant correlation observed between the starting classification and gain in velopharyngeal function. The gain observed was greater as the initial velopharyngeal function was worse (p = 0.035). The use of an algorithm combining clinical assessment with a standardized classification of the velopharyngeal function proved to be a reliable tool for the indication of surgery in patients with VPI. A close follow up is essential in a multidisciplinary team., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2023. Published by Elsevier Masson SAS.)

The aim of this retrospective study was to evaluate results of four different surgical approaches to palatoplasty and to demonstrate which type showed the lowest number of cases with the need for secondary surgeries. The results of 227 patients who underwent cleft palate surgical repair over a 13-year period (2000-2012) were included. The incidence rates of oronasal fistula, velopharyngeal insufficiency with the need of pharyngeal flap and pharyngoplasty were examined. The need for revision surgery was found in 48 patients (21.1 %). A significantly higher rate of cases with the need for secondary correction was found in patients with a complete cleft (44 %) as compared to patients with incomplete cleft palate (9.8 %). A higher percentage for additional surgery was noted after the Bardach procedure (50 %) as opposed to the lower revision rate after Veau-Wardill-Kilner (22.8 %) and Furlow (17.6 %). After the von Langenbeck procedure, the need for revision eventuated only in 5.5 % of cases. It is important to mention that there were no significant differences in the incidence of secondary surgery between the patients with cleft palate with or without the presence of Pierre Robin sequence. Neither there was observed a significant difference in the incidence of additional surgery between male and female patients. However, a higher need for pharyngeal flap was noted in the female group (Tab. 8, Ref. 38). [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy and resource utilization of through-and-through dissection of the soft palate for pharyngeal flap inset for velopharyngeal incompetence (VPI) of any indication. Design: Retrospective review. Setting: Tertiary care center. Patients: Thirty patients were included. Inclusion criteria were diagnosis of severe VPI based on perceptual speech assessment, confirmed by nasoendoscopy or videofluoroscopy; VPI managed surgically with modified pharyngeal flap with through-and-through dissection of the soft palate; and minimum 6 months follow-up. Patients with 22q11.2 deletion syndrome were excluded. Intervention: Modified pharyngeal flap with through-and-through dissection of the soft palate. Main Outcome Measure(s): Velopharyngeal competence and speech assessed using the Speech-Language Pathologist 3 scale. Results: The median preoperative speech score was 11 of 13 (range, 7 to 13), which improved significantly to a median postoperative score of 1 of 13 (range 0-7; P <.001). Velopharyngeal competence was restored in 25 (83%) patients, borderline competence in 3 (10%), and VPI persisted in 2 (7%) patients. Complications included 1 palatal fistula that required elective revision and 1 mild obstructive sleep apnea that did not require flap takedown. Median skin-to-skin operative time was 73.5 minutes, and median length of stay (LOS) was 50.3 hours. Conclusions: This technique allows direct visualization of flap placement and largely restores velopharyngeal competence irrespective of VPI etiology, with low complication rates. Short operative time and LOS extend the value proposition, making this technique not only efficacious but also a resource-efficient option for surgical management of severe VPI. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate speech outcomes following surgical intervention for velopharyngeal dysfunction (VPD). Perceptual speech outcome data were subsequently analyzed in conjunction with patient factors such as congenital abnormalities, presence of cleft lip and/or palate, and age of repair. We hope to aid in the eventual creation of treatment algorithms for VPD, allowing practitioners to tailor surgical technique selection to patient factors. Methods: A retrospective analysis was performed for all patients who underwent surgical correction of VPD at London Health Sciences Centre between the years 2005 and 2018. Two hundred and two consecutive VPD patients (median age 10.6 years) were followed for an average of 20.2 months after having undergone a superiorly based pharyngeal flap (121), Furlow palatoplasty (72), or sphincteroplasty (9). Speech outcomes were measured via the American Cleft Palate-Craniofacial Association (ACPA) perceptual speech assessment, and MacKay-Kummer Simplified Nasometric Assessment Procedures Revised (SNAP-R) was used to measure nasalence. Comparisons of mean preoperative and postoperative outcomes were made, as well as analyses regarding surgical procedure, syndrome, cleft status, and age. Results: Mean perceptual scores improved significantly postoperatively (p <.0001), and successful perceptual resonance was identified in 86.1% patients (n = 174). Postoperative perceptual speech scores for three ACPA domains were superior with pharyngeal flap compared to both Furlow palatoplasty and sphincteroplasty ([hypernasality: p <.001, p <.02], [audible nasal emissions: p <.002, p <.05], [velopharyngeal function: p <.001, p <.05]). Success rate was higher in pharyngeal flap (94.2%) than in Furlow palatoplasty (75.0%, p <.001) or sphincter pharyngoplasty (66.7%, p <.001). No significant difference was identified in success rate based on syndrome or cleft status. Conclusion: Operative management of VPD is highly effective in improving perceptual speech outcomes. Given proper patient selection, all three procedures are viable treatment options for VPD. For those patients identified as appropriate to undergo a pharyngeal flap, robust improvements in speech outcomes were observed. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated the effects of suspension pharyngeal flap surgery for velopharyngeal insufficiency (VPI) due to cleft palate., Methods: Ten Filipino individuals (mean age = 20.63 years, range = 8.4-34.9 years) with a cleft palate who underwent suspension pharyngeal flap surgery for VPI were included in this study. Perceptual and instrumental speech assessments were conducted at two different time points: before surgery (data point 1) and after surgery (data point 2, range = 4-26 weeks postoperatively). Speech intelligibility in different contexts and satisfaction with speech were assessed by the participants themselves using a self-report questionnaire. Additionally, the risk for obstructive sleep apnea was assessed using the Berlin Questionnaire., Results: Velopharyngeal gap size significantly decreased after the surgery. Additionally, significant improvements in speech understandability and acceptability were observed following the suspension pharyngeal flap procedure. Besides, a significant reduction in hypernasality, nasal emission, and the occurrence of passive articulation errors was seen. No difference in the occurrence of active articulation errors was observed when comparing data pre- and post-surgery. The ten individuals reported to be significantly more intelligible in different contexts after surgery., Conclusion: Improved speech was observed in individuals who received the suspension pharyngeal flap procedure. This procedure also positively influences an individual's intelligibility in different contexts in daily life. In individuals with persisting active articulation errors, post-surgery speech therapy will still be necessary., (© 2024 S. Karger AG, Basel.)

Objective: Compare the effectiveness of palatoplasty and pharyngoplasty procedures at resolving hypernasality in patients with 22q11.2 deletion syndrome (22q)., Design: Retrospective cohort study., Setting: Metropolitan children's hospital., Patients: Fourteen patients with 22q presenting for management of velopharyngeal insufficiency., Interventions: Palatoplasty or pharyngoplasty procedure., Main Outcome Measure: Resolution of hypernasality 12 months postoperatively., Results: Both procedure groups had a mean preoperative velopharyngeal gap of 6.2 mm during phonation. No patient who underwent palatoplasty achieved resolution of hypernasality; 1/7 patients had worse hypernasality, 4/7 had no change, and 2/7 had improved hypernasality. In contrast, hypernasality was resolved in 6/7 patients in the pharyngoplasty group, which was significantly ( P  = .03) higher than the palatoplasty group., Conclusions: In patients with 22q, palatoplasty procedures may be less effective than pharyngoplasty procedures at resolving hypernasality. This may be due to underlying anatomic or physiologic differences, such as increased pharyngeal depth and hypodynamic muscles., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Approximately 30% of patients with a history of repaired cleft palate (CP) go on to suffer from velopharyngeal dysfunction (VPD). This study discusses the operative management of VPD and postoperative speech outcomes in a cohort of CP patients., Setting: An academic tertiary pediatric care center., Methods: Retrospective cohort study., Patients: Patients with history of repaired CP (Veau I-IV) who underwent operative management of VPD between January 1st, 2010 and December 31st, 2020. Operative modalities were posterior pharyngeal flap (PPF), sphincter pharyngoplasty (SPP), Furlow palate re-repair, and buccal myomucosal flap palate lengthening (PL)., Outcome Measures: The primary outcome measure is postoperative speech improvement evaluated by the Pittsburgh Weighted Speech Scale (PWSS)., Results: 97 patients met inclusion criteria. 38 patients with previous straight-line primary palatoplasty underwent Furlow re-repair; these patients were significantly younger (7.62 vs 11.14, P  < .001) and were more likely to have severe VPD per PWSS (OR 4.28, P  < .01, 95% CI 1.46-12.56) when compared to VPD patients with previous Furlow repair. 21.1% of these patients required an additional non-revisional VPD procedure. The remaining patients underwent a non-revision procedure (26 PPF, 22 SPP, 11 PL); all experienced significant ( P  < .001 on paired t-test) reductions in PWSS total and subgroup VPD severity scores without difference in improvement between operation types. SPP was statistically associated with all-cause complication (OR 2.79, 95% CI 1.03-7.59, P  < .05) and hyponasality (OR 3.27, 95% CI 1.112-9.630, P  < .05)., Conclusion: Furlow re-repair reduced need for additional VPD operations. Speech outcomes between non-revisional operations are comparable, but increased complications were seen in SPP., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: (1) To determine the incidence rate of velopharyngeal dysfunction (VPD) according to 7 speech criteria post-Furlow palatoplasty. (2) To find an anatomical measurement of the cleft palate (or combination of measurements) associated with the occurrence of VPD. Study design: Retrospective cohort study. Participants and Methods: Fifty-six patients with cleft palate ± cleft lip underwent palatoplasty with the Furlow technique at the age of 10 months. Pre-and post-palatoplasty cleft palate measurements were collected during the procedure. Three blinded speech-language pathologists (SLPs) retrospectively scored the patients from the chart data at age 4. Student t test and receiver operating characteristic curve analysis were used to evaluate the association and predictive capacity between cleft measurements and parameters (M&P) with all VPD criteria. Results: The SLPs found an incidence of VPD according to 7 criteria: hypernasality (11%), audible nasal emission (4%), nasal rustle (14%), compensatory errors (4%), impairment of speech understandability (7%), and impairment of speech acceptability (16%). The SLPs recommended a secondary surgical procedure in 5 patients (9%). A statistically significant association was found between, respectively, 17 and 5 M&P and the occurrence of compensatory errors and audible nasal emission. Our data suggest that the length of the cleft, the cleft area, and the postoperative transversal size of the nasopharynx are the best indicators of the future positivity of VPD criteria. Conclusion: The size of the postoperative transverse nasopharyngeal area during the primary cleft palate procedure may become the focus of the next generation of cleft surgeons to reduce the incidence of VPD. [ABSTRACT FROM AUTHOR]

Velopharyngeal insufficiency (VPI) results from defects interfering with closure of the velopharyngeal port. It can lead to many issues ranging from nasal regurgitation to severe speech abnormalities. Treatment is tailored to patient-specific etiology and severity, often involving surgical correction. A rare, and therefore seldom, described cause of VPI is isolated unilateral agenesis of the soft palate. We describe the case of a 2-year-old patient with Stickler syndrome possessing a unique anatomic presentation of this pathology, managed successfully with a unilateral pharyngeal flap. [ABSTRACT FROM AUTHOR]