Treatment of Velopharyngeal Insufficiency: Fifteen-Year Experience at the University of Florida.

INTRODUCTION: A 15-year experience treating velopharyngeal insufficiency at the University of Florida is presented. After diagnostic speech evaluation, preoperative videofluoroscopy was the primary method used to evaluate the function of the velopharyngeal port. METHODS: Chart reviews of all patients with velopharyngeal insufficiency, including patients with failed palatal cleft surgery, submucous cleft palate, and noncleft palate who met study criteria were included. RESULTS: Overall success of treatment was 92%. Results are described by subgroups for further clarification. CONCLUSION: Selection of surgical procedure based on preoperative evaluation of velopharyngeal function and anatomy leads to a high rate of success.

Parental perception vs. professional assessment of speech changes following premature loss of maxillary primary incisors.

PURPOSE: This study's purpose was to compare parental perceptions of children's speech changes with a professional speech assessment following premature extractions of maxillary primary incisors (PEMPI). METHODS: Healthy 5- to 6-year-olds, with no cognitive and speech delay and who received PEMPI between the ages of 2 and 4 years old at a university-based clinic, were recruited for the study. First, their parents took part in a telephone interview regarding their perceptions of speech changes following the extractions. The children were then invited to undergo individual speech evaluations by a certified speech and language pathologist. RESULTS: Of 204 patients identified from the database, 57 parental interviews were completed. Sixty percent (34) felt their children sounded different following extractions, and 65% (37) reported difficulty with pronunciation of the "s" sound. For children who were perceived by their parents to sound different, 46% had problems pronouncing words with the letters s and z. For parents who did not perceive speech changes, none of the children had problems with s and z as determined by the professionally conduced speech evaluations (Fisher exact test P=.02). CONCLUSIONS: Children who undergo premature extractions of maxillary primary incisors show problems articulating words containing s and z, and there is an agreement between parental perceptions and actual disarticulations detected from a professional assessment.

Evaluation and treatment of velopharyngeal insufficiency: the University of Florida experience.

This retrospective study spans the years 1988 to 2000 and looks specifically at the treatment procedures and outcomes for the correction of velopharyngeal insufficiency (VPI). Ninety-eight patients underwent preoperative assessment by speech pathologists that included perceptual speech evaluation, videofluoroscopy, and, for some, nasendoscopy. Based on this evaluation protocol, a specific surgical procedure was chosen to serve the patients' needs. The four procedures of choice were the palatal pushback with a pharyngeal flap lining, sphincter pharyngoplasty, a superiorly based obturating pharyngeal flap, and Furlow palatoplasty. The criteria for selecting these procedures are reviewed. The results revealed VPI resolution and the establishment of normal nonnasal speech in more than 95% of the 75 patients for whom outcomes were determined. This study reiterates the importance of thorough preoperative evaluation and the individualization of the secondary corrective procedure.