Surgical correction of velopharyngeal insufficiency in cleft palate patients with two procedures of reconstruction of radical intravelar veloplasties (IVVs) / 中华医学美学美容杂志

Objective To summarize the clinical outcomes of surgical correction of velophary geal insufficiency (VPI) with two procedures of radical intravelar veloplsties,and to discuss the indication selection of surgical technique.Methods 58 cases of various cleft palate were speech evaluated and diagnosed as mild to moderate VPI,who aged from 3 to 28 years (mean age 7.5 years).Group Ⅰ (36 cases) were performed surgery in the way of modified Furlow double-opposing Z-plasty.Group Ⅱ (22 cases) were performed surgery in the way of Sommerald radical IVV.All cases were followed up for 6 months to 1 year after surgery,with speech evaluation and objective examination of nasopharygoscopy and fixed position lateral X ray.The X-ray images of lateral view of velum was read through PACS image system.The effective work length of soft palate and the pharyngeal gap of the velum at rest and function were measured directly through PACS system.The data of each case before and after surgery were compared.Results 34 of 36 cases (94.50％) in modified-Furlow group and 21 of 22 cases (95.5％) in Sommerlad group finally recovered complete velopharyngeal closure.Compared between before and post operation,the effective work length of soft palate in modified Furlow group increased by 9.50±2.35 mm,the length in Sommerlad group increased by 7.50±3.32 mm.The differences were statistically significant by paired T test (P＜0.001).None of all cases complained nasal airway obstruction.Conclusions Both types of radical IVVs are highly effective to be recommended for surgical correction of mild to moderate VPI.Strict selection of surgical indication and excellent surgical skill are necessary for good treatment outcomes.

Individualized management of velopharyngeal insufficiency for cleft lip and palate / 中华整形外科杂志

Objective@#Velopharyngeal insufficiency (VPI) is a common postoperative sequela secondary tocleft palate. It could significantly impairpatients′living quality. Treatment of VPI includes surgery and speech therapy, but the reported success rates are inconsistent. A consensus in the literatures is needed, to guide procedure selection for patients with VPI.@*Methods@#This is a retrospective study on management options for patients with VPI.This study systematically introduces the assessment, management plan and treatment effect of VPI, in the Craniofacial center of Hospital Stomatology of Xi′an Jiaotong University.The challenges of VPI diagnosis and treatment with cleft palate are discussed in-depth.@*Results@#Most patients with VPI underwent evaluation and treatment (surgical or/and speech therapy) had speech improvement. The average value of hypernasality decreased from 3.67 before interventions to 1.57 after interventions.A multidisciplinary team using multi-modal to evaluate velopharyngeal function and speech. All patients had no bleeding, would dehiscence or fistula postoperatively. The difficulty of stimulability test was significantly reduced. Fourteen patients completed speech therapy, with the averaged treatments period of 3 months.@*Conclusions@#Speech pathologist is the manager of speech rehabilitation of cleft palate patients with VPI. The operation skill plays a key role in the treatment of VPI. Detailed diagnostic information is important for performing excellent surgical techniques. The cooperation of surgeon and speech pathologist, could be helpful to achieve the final speech rehabilitation.

Effectiveness of Furlow palatoplasty in velopharyngeal insufficiency after cleft palate surgery / 中国修复重建外科杂志

Objective: To explore the application value of Furlow palatoplasty in reconstruction of velopharyngeal insufficiency (VPI) after cleft palate surgery. Methods: Between August 2015 and January 2017, 48 patients with VPI after cleft palate surgery were treated with Furlow palatoplasty. There were 29 males and 19 females, aged from 4 to 17 years (mean, 6.1 years). There were 16 cases of incomplete cleft palate and 32 cases of complete cleft palate; and 16 cases of soft cleft palate and 32 cases of soft and hard cleft palate. The interval between first cleft palate surgery and Furlow palatoplasty was 3 to 13 years (mean, 5.9 years). The patients were accompanied by significant open rhinolalia and nasal leakage. The degree of velopharyngeal closure assessed by electronic nasopharyngeal fiberoptic endoscopy was grade Ⅲ. The operation time and intraoperative blood loss were recorded. The total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch were measured before operation and at immediate after operation, and the change of the above indexes before and after operation was calculated. According to the results of clinical assessment, the patients were allocated into three groups: velopharyngeal competence (VPC) group, marginal velopharyngeal inadequacy (MVPI) group, and VPI group. The relationship between the soft palate and the posterior pharyngeal wall was evaluated by lateral cephalometric radiographs at 3 months after operation, and the patients were allocated into complete contact group, point contact group, and non-contact group. The velopharyngeal closure was evaluated by electronic nasopharyngeal fiberoptic endoscopy (grade Ⅰ, Ⅱ, Ⅲ). Spearman analysis was used to analyze the correlation between the changes of the total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch before and after operation. The contact degree of soft palate and posterior pharyngeal wall and the closure degree of pharynx and palate were grouped separately, and the above indexes were analyzed statistically. Results: The operation time was 35-64 minutes (mean, 41 minutes); the intraoperative blood loss was 3-10 mL (mean, 6 mL). All patients were followed up 3 months. After 3 months of operation, the clinical evaluation results were 34 cases of VPC, 7 cases of MVPI, and 7 cases of VPI. Lateral cephalometric radiographs showed that 30 cases had complete contact with the posterior pharyngeal wall, 11 cases had point contact, and 7 cases had no contact. Electronic nasopharyngeal fiberoptic endoscopy showed that the pharyngeal closure function was improved to varying degrees, 29 cases of grade Ⅰ, 12 cases of grade Ⅱ, and 7 cases of grade Ⅲ. There were significant differences in the total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch between pre- and post-operation ( P0.05). There were significant differences in the changes of total length of palate and the length soft palate before and after operation between complete contact, point contact, and non-contact groups ( P0.05). Conclusion: Furlow palatoplasty can restore the VPI after cleft palate surgery, which can effectively prolong the soft palate and reduce the depth of the pharynx. It can cover the physiological and anatomical morphology of velopharyngeal closure significantly and improve the velopharyngeal function.

Application of modified Bardach two-flaps palatoplasty combined modified Furlow double-opposing Z-plasty in wide palatal cleft repair / 中华医学美学美容杂志

Objective To explore the effectiveness of modified Bardach two-flap palatoplasty combined modified Furlow double-opposing Z-plasty in wide palatal cleft repair.Methods 80 patients aged 2-18 years old with Ⅲ cleft palate from our department were divided into two groups,the experimental group (n=40) was repaired with modified Bardach two-flaps palatoplasty combined modified Furlow double-opposing Z-plasty (modified B+F technique).The control group (n =40) was repaired with Sommerlad levator muscle of palatine velum reconstruction (S technique).Results The healing of incisions was better in the experimental group than the control group.The fistula rate in the experimental group was 2.5％,which seemed to be remarkable lower than that of the control group (7.5％) post operation one month.Conclusions Application modified Bardach two-flaps palatoplasty combined modified Furlow double-opposing Z-plasty in wide palatal cleft will promote healing of incisions,reduce the occurrence rate of cleft palate fistuia,inhibit the scar contracture of soft palate,maintain the length of soft palate,augment movement of soft palate,and improve the speech quality of patients.

Comparative Study of Surgical Technique for the Correction of the Congenital Cleft Palate in Mongolia

Congenital Palatal Fistula with Submucous Cleft Palate

Congenital palatal fistulas are rare, and few cases have been reported. Most reported cases present with a submucous cleft palate. In terms of etiology, whether the fistula is congenital or acquired has been debated. Moreover, there is not a generally accepted surgical procedure for repair of palatal fistulas. We present a case of a congenital palatal fistula with a submucous cleft palate that was successfully treated with a Furlow doubleopposing Z-plasty. We discuss palatal fistulas with a review of the literature.

Furlow Palatoplasty in Submucous Cleft Palate-Timing of Operation

PURPOSE: In order to determine the differences in speech outcome based on timing of operation in submucous cleft palate, we have reviewed our experiences in the Furlow palatoplasty over the last 11 years. METHODS: From March 1996 to March 2006, 38 submucous cleft palate patients received Furlow palatoplasty. 10 developmentally delayed patients were excluded and 5 patients were lost to follow up. The rest 23 patients were reviewed. Speech was evaluated preoperatively and postoperatively, and speech therapy was performed accordingly. Perceptual speech assessment included hypernasality, nasal emission and articulation disorder. Cinefluorography was performed to aid perceptual assessment. Based on timing of operation, the patients were divided into 3 groups as following: Group A under 24 months(8 patients), Group B from 25 to 48 months(6 patients), and Group C over 49 months (9 patients). Except 1 patient under speech therapy yet, resultant speech was compared. RESULTS: The rate of abnormal speech was higher in Group C(3/9, 33.3%) than in Group A(0%) or B(0%). All 3 patients who had been discontinued of speech therapy from the parent's judgment had abnormal speech. The reason for the discontinuation was that the regular speech therapy was a burden at school age. Any patients who had continued speech therapy had normal speech. CONCLUSION: The results of our study shows that operative timing is associated with speech development. Maintenance of speech therapy was an important factor for normal speech development. It will be helpful to perform a palatoplasty before 48 months of age to complete speech therapy before the school age.

Speech Outcome and Timing of Furlow Palatoplasty in Cleft Palate

Palatoplasty using Furlow's double-opposing Z-plasty has been performed from June, 1995 to September, 1999 at Seoul National University Children's Hospital. The goal of this study is to determine the optimal timing of repair and cleft severity affecting velopharyngeal function. This is the retrospective study of patients operated by the second author. The mean age of patients was 10.53 months. The patients could be divided into three groups-isolated cleft palate(n=70), unilateral cleft lip and palate(n=88), and bilateral cleft lip and palate(n=42). To evaluate the velopharyngeal function, we used two parameters, speech evaluation and cineofluorography using DSR(digital subtraction radiography). Also, to determine the relevance between cleft severity and speech development, we measured the distance between maxillary tuberosities and cleft margins. Among 200 patients, about 96% had no or minimal hypernasality and 87% had no or mild nasal emission. The cleft width and length of soft palate seemed not to be related with the speech development. Palatoplasty at the age under 12 months resulted in less 'nasal emission' and better 'articulation' of the parameters that were assessed at the age of 7 years. It can be concluded Furlow palatoplasty shows satisfactory results and also it seems that it is better to perform the operation before the age of 12 months.

Usefulness of Speech Therapy for Patients with Submucous Cleft Palate Treated with Furlow Palatoplasty

Furlow palatoplasty has been favored by many plastic surgeons as the primary treatment for the velopharyngeal insufficiency associated with submucous cleft palate. The purpose of this article is to introduce an efficacy of Furlow palatoplasty and speech therapy performed on patients who were diagnosed belatedly as having submucous cleft palates. From 2002 to 2004, four submucous cleft palate patients over 5 years of age with velopharyngeal insufficiency received Furlow palatoplasty. The patients were evaluated through the preoperative perceptual speech assessment, nasometry, and videonasopharyngoscopy. Postoperatively, two patients achieved competent velopharyngeal function in running speech. One of the remaining two could achieve competent velopharyngeal function with visual biofeedback speech therapy and the other could not use her new velopharyngeal function in running speech because of her age. Speech therapy can correct the articulation errors and thus improve the velopharyngeal function to a certain extent by eliminating some compensatory articulations that might have an adverse influence on velopharyngeal function. This study shows that Furlow palatoplasty can successfully correct the velopharyngeal insufficiency in submucous cleft palate patients and speech therapy has a role in reinforcing surgical result. But age is still a restrictive factor even though surgery was well done.

Effect of Furlow Palatoplasty for Correction of Submucous Cleft Palate: Cephalometric and Speech Analysis

The purpose of this study was to investigate the anatomic and functional changes of submucous cleft palate operated with Furlow palatoplasty. A total of 36 patients with submucous cleft palate underwent Furlow palatoplasty from 1993 to 1998. The mean follow-up period was 5 years 3 months. Midfacial growth was measured using lateral cephalograms in 18 patients, whose age was older than 8 years of age. Speech analyses were performed in 25 patients by the same speech pathologist for the degrees of nasality and articulation. The parameters obtained in the lateral cephalogram were compared with a healthy population in Korea. ANS-PNS was in 61.1% within the clinical normal range for the age group. SNA and SNB were in 55.6% within the normal range. ANB was in 72.2% and Ba-PNS was 50.0% within the range. The postoperative nasality scores of open vowels and round vowels were 24.2% and 25.2%, respectively, which were lower than preoperative scores. The mean articulation accuracy value was 92.9% which was higher than preoperative value. Our results suggest that Furlow palatoplasty is a useful procedure as the initial treatment of the submucous cleft palate and has the advantages in both aspects of speech results and facial growth.

Surgical Correction of Submucous Cleft Palate with Furlow's Palatoplasty

Furlow's palatoplasty has been used as the primary treatment for cleft palate. From 1991 to 1999, 24 submucous cleft palate patients underwent Furlow's palatoplasty. The follow-up period was 3 months to 8 years (mean 24 months). Patients were selected after a thorough study for velopharyngeal insufficiency including intraoral examinatioin, speech assessment, digital subtraction radiography (DSR). Postoperatively velopharyngeal function was reevaluated with speech assessment and digital subtraction radiography in the 7 cooperative patients. Speech parameters including hypernasality, nasal emission, and Allison scale were improved after surgery. Digital subtraction radiography provided the value of velopharyngeal gap and the degree of the motion of lateral pharyngeal wall, both of which were improved after surgery. Furlows palatoplasty has advantage such as no impairment of nasopharyngeal physiology, no hannful effect on the hard palate and the realignment of the levator muscle which plays important role on the movement of the soft palate. The results show that a Furlow's palatoplasty can satisfactorily correct velopharyngeal insufficiency in carefully selected submucous cleft palate patients.