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Salvage Of Speech With Secondary Tissue Augmenting Furlow Palatoplasty
Erin Anstadt MD, Wendy Chen MD, MS, Fady Paul Marji MD, Sean Herman MD, James Fisher PhD, Jesse Goldstein, MD, Joseph Losee, MD
University of Pittsburgh Medical Center
2020-02-13
Presenter: Erin Anstadt MD
Affidavit:
Vu Nguyen
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
INTRODUCTION: Recurrent or persistent velopharyngeal incompetence (VPI) after primary palatoplasty often necessitates secondary palatoplasty or pharyngoplasty. This study reviews the results of using autologous tissue to augment secondary palatoplasty as a strategy to salvage speech prior to pharyngoplasty.
METHODS: This is a retrospective review of two surgeons' experience using tissue augmentation in secondary palatoplasty procedures from 2017 to 2019. Patients who underwent revision or conversion Furlow palatoplasty with tissue augmentation (buccal myomucosal flap, buccal fat pad flap, and/or structural fat grafting) for VPI, despite speech therapy and a dynamic levator mechanism, were included. Speech was assessed using Pittsburgh Weighted Speech Scores (PWSS) and qualitative speech evaluations by Speech-Language Pathologists.
RESULTS: Twelve patients were included. 50% were female. 58% were syndromic. Veau I, III, and IV clefts were respectively reported in 2 patients (17% each). Submucous and Veau II clefts were respectively reported in 3 patients (25% each). In secondary palatoplasty, 10 patients received buccal fat flaps (83%), 5 had myomucosal flaps (42%), 2 had structural fat grafting (17%; mean 1.4mL in volume). Mean (±SD) age at secondary surgery was 9.4 (±4.3) years. Mean (±SD) length of follow-up was 11.3 (±8) months. Paired T-test analysis showed statistically significant improvements between initial and post-revision mean(±SD) PWSS, 13.9 (±6.8) and 3.4 (±1.8) respectively (p≤0.0003). All patients improved on qualitative speech assessments.
CONCLUSION: Augmenting secondary palatoplasty with vascularized tissue facilitates the obliteration of dead space, lengthening of the velum, and reduced tension on closures. We found consistent improvements in speech outcomes with this technique.
