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DOI: 10.1055/a-2263-7857
Incidence of Velopharyngeal Insufficiency after Primary Cleft Palate Repair: A 27-Year Assessment of One Surgeon's Experience
Funding This work was supported by a 2-year Research Grant from Pusan National University.
Abstract
Background Velopharyngeal insufficiency (VPI) is a major complication of cleft palate repair. The purpose of this study was to evaluate the incidence and predictive factors of VPI after cleft palate repair based on 27 years of one surgeon's experience.
Methods Medical records were retrospectively reviewed for 652 patients who underwent cleft palate repair between 1995 and 2021. After exclusion of those with other syndromes or developmental disorders, the study included 374 patients with sufficient follow-up until the age of 4 years, when language evaluation was possible. VPI status was categorized through subjective and objective tests into normal, VPI, and borderline. We analyzed potential differences in VPI incidence by multiple factors. Factors with significance were analyzed to confirm the relationships between subvariables.
Results Of the 374 patients, 311 (83.2%) exhibited normal pronunciation, 51 (13.6%) had VPI, and 12 (3.2%) were borderline. Primary cleft palate repair performed after 18 months was associated with a higher incidence of VPI than repair conducted before 18 months (p = 0.005). The incidence of VPI was higher in cases of submucous cleft palate than in the other types based on the Veau classification (p = 0.011). However, in the multivariable analysis, only the submucous type showed statistically significant results (p = 0.026).
Conclusion A total of 374 people underwent primary cleft palate repair, and 13.6% of those with VPI required secondary therapy. The incidence of VPI was relatively high among patients with primary cleft palate repair after 18 months and patients with submucous cleft palate.
Authors' Contributions
Y.C.B. was responsible for conceptualization. C.W.J. was responsible for writing—original draft. H.J.S. was responsible for writing—review and editing. Y.S.C. was responsible for resources.
Ethical Approval
The study was approved by the Institutional Review Board of Pusan National University Hospital (IRB No. H-2210-018-120).
Patient Consent
There are no images or data requiring patient consent.
Note
This work was presented at The 12th Research & Reconstruction Forum.
Publikationsverlauf
Eingereicht: 10. Februar 2023
Angenommen: 30. Januar 2024
Accepted Manuscript online:
07. Februar 2024
Artikel online veröffentlicht:
09. Mai 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Ryu JY, Park TH, Cho BC, Choi KY. The prevalence, risk of premature births, mortality and causes of death of cleft lip with or without palate in South Korea: a nationwide population-based cohort study. Int J Epidemiol 2022; 51 (03) 974-983
- 2 Tanaka SA, Mahabir RC, Jupiter DC, Menezes JM. Updating the epidemiology of cleft lip with or without cleft palate. Plast Reconstr Surg 2012; 129 (03) 511e-518e
- 3 Kummer AW. A pediatrician's guide to communication disorders secondary to cleft lip/palate. Pediatr Clin North Am 2018; 65 (01) 31-46
- 4 Lithovius RH, Ylikontiola LP, Sándor GK. Frequency of pharyngoplasty after primary repair of cleft palate in northern Finland. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117 (04) 430-434
- 5 Hopper RA, Tse R, Smartt J, Swanson J, Kinter S. Cleft palate repair and velopharyngeal dysfunction. Plast Reconstr Surg 2014; 133 (06) 852e-864e
- 6 Carvajal Álvarez DC, Palomares-Aguilera MM, Meneses Geldres MB, Villarroel Giugliano C. Primary palatal surgery in nonsyndromic cleft palate children and velopharyngeal insufficiency correction outcomes. J Craniofac Surg 2021; 32 (02) 698-704
- 7 Schuster T, Rustemeyer J, Bremerich A, Günther L, Schwenzer-Zimmerer K. Analysis of patients with a cleft of the soft palate with special consideration to the problem of velopharyngeal insufficiency. J Craniomaxillofac Surg 2013; 41 (03) 245-248
- 8 Jackson O, Stransky CA, Jawad AF. et al. The Children's Hospital of Philadelphia modification of the Furlow double-opposing Z-palatoplasty: 30-year experience and long-term speech outcomes. Plast Reconstr Surg 2013; 132 (03) 613-622
- 9 Anderson BJ, Fallah KN, Lignieres AA. et al. Predictive factors for velopharyngeal insufficiency following primary cleft palate repair. Cleft Palate Craniofac J 2022; 59 (07) 825-832
- 10 Inman DS, Thomas P, Hodgkinson PD, Reid CA. Oro-nasal fistula development and velopharyngeal insufficiency following primary cleft palate surgery–an audit of 148 children born between 1985 and 1997. Br J Plast Surg 2005; 58 (08) 1051-1054
- 11 Phua YS, de Chalain T. Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990 and 2004. Cleft Palate Craniofac J 2008; 45 (02) 172-178
- 12 Sullivan SR, Marrinan EM, LaBrie RA, Rogers GF, Mulliken JB. Palatoplasty outcomes in nonsyndromic patients with cleft palate: a 29-year assessment of one surgeon's experience. J Craniofac Surg 2009; 20 (Suppl. 01) 612-616
- 13 Wu R, Cheraghlou S, Parsaei Y, Travieso R, Steinbacher DM. Does cleft palate width correlate with Veau classification and outcome?. J Craniofac Surg 2017; 28 (05) 1369-1374
- 14 Deshpande GS, Campbell A, Jagtap R. et al. Early complications after cleft palate repair: a multivariate statistical analysis of 709 patients. J Craniofac Surg 2014; 25 (05) 1614-1618
- 15 Bluher AE, Cunningham TD, Reeves TD. Effect of cleft palate repair timing on inpatient complication rate: review of a national database. J Craniofac Surg 2021; 32 (02) 466-468
- 16 Eliason MJ, Hadford S, Green L, Reeves T. Incidence of fistula formation and velopharyngeal insufficiency in early versus standard cleft palate repair. J Craniofac Surg 2020; 31 (04) 980-982
- 17 Hosseinabad HH, Derakhshandeh F, Mostaajeran F. et al. Incidence of velopharyngeal insufficiency and oronasal fistulae after cleft palate repair: a retrospective study of children referred to Isfahan Cleft Care Team between 2005 and 2009. Int J Pediatr Otorhinolaryngol 2015; 79 (10) 1722-1726
- 18 Yuan N, Dorafshar AH, Follmar KE, Pendleton C, Ferguson K, Redett III RJ. Effects of cleft width and Veau type on incidence of palatal fistula and velopharyngeal insufficiency after cleft palate repair. Ann Plast Surg 2016; 76 (04) 406-410
- 19 Dudas JR, Deleyiannis FW, Ford MD, Jiang S, Losee JE. Diagnosis and treatment of velopharyngeal insufficiency: clinical utility of speech evaluation and videofluoroscopy. Ann Plast Surg 2006; 56 (05) 511-517 , discussion 517
- 20 Pigott RW, Bensen JF, White FD. Nasendoscopy in the diagnosis of velopharyngeal incompetence. Plast Reconstr Surg 1969; 43 (02) 141-147
- 21 Skolnick ML. Videofluoroscopic examination of the velopharyngeal portal during phonation in lateral and base projections–a new technique for studying the mechanics of closure. Cleft Palate J 1970; 7: 803-816
- 22 Kim JH, Bae YC, Hwang SM. Simple method of speech evaluation in the Korean patient with cleft palate. J Korean Soc Plast Reconstr Surg. 1999; 26: 858-865
- 23 Sullivan SR, Vasudavan S, Marrinan EM, Mulliken JB. Submucous cleft palate and velopharyngeal insufficiency: comparison of speech outcomes using three operative techniques by one surgeon. Cleft Palate Craniofac J 2011; 48 (05) 561-570
- 24 Bae YC, Lee JW, Seo HJ. Modified palatoplasty method (Busan modification) for incomplete type cleft palate. J Craniofac Surg 2015; 26 (04) 1203-1206
- 25 Phillips JH, Klaiman P, Delorey R, MacDonald DB. Predictors of velopharyngeal insufficiency in cleft palate orthognathic surgery. Plast Reconstr Surg 2005; 115 (03) 681-686
- 26 OECD. OECD Reviews of Public Health: Korea; 2020 , Accessed March 11, 2022, Available at: https://www.oecd.org/health/oecd-reviews-of-public-health-korea-be2b7063-en.htm
- 27 Reiter R, Brosch S, Wefel H, Schlömer G, Haase S. The submucous cleft palate: diagnosis and therapy. Int J Pediatr Otorhinolaryngol 2011; 75 (01) 85-88
- 28 Ha KM, Cleland H, Greensmith A. et al. Submucous cleft palate: an often-missed diagnosis. J Craniofac Surg 2013; 24 (03) 878-885
- 29 Marrinan EM, LaBrie RA, Mulliken JB. Velopharyngeal function in nonsyndromic cleft palate: relevance of surgical technique, age at repair, and cleft type. Cleft Palate Craniofac J 1998; 35 (02) 95-100
- 30 Bicknell S, McFadden LR, Curran JB. Frequency of pharyngoplasty after primary repair of cleft palate. J Can Dent Assoc 2002; 68 (11) 688-692
- 31 Yang Y, Li Y, Wu Y. et al. Velopharyngeal function of patients with cleft palate after primary palatoplasty: relevance of sex, age, and cleft type. J Craniofac Surg 2013; 24 (03) 923-928
- 32 Brothers DB, Dalston RW, Peterson HD, Lawrence WT. Comparison of the Furlow double-opposing Z-palatoplasty with the Wardill-Kilner procedure for isolated clefts of the soft palate. Plast Reconstr Surg 1995; 95 (06) 969-977
- 33 Williams WN, Seagle MB, Pegoraro-Krook MI. et al. Prospective clinical trial comparing outcome measures between Furlow and von Langenbeck Palatoplasties for UCLP. Ann Plast Surg 2011; 66 (02) 154-163
- 34 Yu CC, Chen PK, Chen YR. Comparison of speech results after Furlow palatoplasty and von Langenbeck palatoplasty in incomplete cleft of the secondary palate. Chang Gung Med J 2001; 24 (10) 628-632