Surgical management of velopharyngeal incompetence in velocardiofacial syndrome.
Cleft Palate Craniofac J
; 41(2): 124-35, 2004 Mar.
Article
em En
| MEDLINE
| ID: mdl-14989693
ABSTRACT
OBJECTIVES:
To analyze the results of surgery for velopharyngeal incompetence (VPI) in velocardiofacial syndrome.DESIGN:
Prospective data collection, with randomized, blind assessment of speech and velopharyngeal function on lateral videofluoroscopy and nasendoscopy.SETTING:
Two-site, tertiary referral cleft unit. PATIENTS Forty-two consecutive patients with the 22q11 deletion underwent surgery for symptomatic VPI by a single surgeon.INTERVENTIONS:
Intraoral examinations, lateral videofluoroscopy (+/- nasendoscopy) and intraoperative evaluation of the position of the velar muscles through the operating microscope. Based on these findings, either a radical dissection and retropositioning of the velar muscles (submucous cleft palate [SMCP repair]) or a Hynes pharyngoplasty (posterior pharyngeal wall augmentation pharyngoplasty) was performed. As anticipated, a proportion of patients undergoing SMCP repair subsequently required a Hynes. The aim of this staged approach was to maximize velar function, thereby enabling a less obstructive pharyngoplasty to be performed. Thus, there were three surgical groups foranalysis:
SMCP alone, Hynes alone, and SMCP+Hynes. MAIN OUTCOMEMEASURES:
Blind perceptual rating of resonance and nasal airflow; blind assessment of velopharyngeal function on lateral videofluoroscopy and nasendoscopy; and identification of predictive factors.RESULTS:
Significant improvement in hypernasality in all three groups. The SMCP+Hynes group also showed significant improvement in nasal emission. There were significant improvements in the extended and resting velar lengths following SMCP repair and a trend toward increased velocity of closure.CONCLUSIONS:
Depending on velopharyngeal anatomy and function, there is a role for SMCP repair, Hynes pharyngoplasty, and a staged combination of SMCP+Hynes, all of which are procedures with a low morbidity.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Insuficiência Velofaríngea
/
Fissura Palatina
/
Procedimentos Cirúrgicos Bucais
/
Cardiopatias Congênitas
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2004
Tipo de documento:
Article