<< Back to the abstract archive
Speech Outcomes Following Clinically Indicated Posterior Pharyngeal Flap Takedown
Evan B. Katzel, MD; Sanjay Naran, MD; Zoe MacIsaac, MD; Liliana Camison, MD; Jesse A. Goldstein, MD; Lorelei J. Grunwaldt, MD; Matthew D. Ford, MS, CCC-SLP; Joseph E. Losee, MD
Division of Pediatric Plastic Surgery
Children's Hospital of Pittsburgh
University of Pittsburgh
2014-03-14
Presenter: Evan B. Katzel
Affidavit:
The work presented here is original and represents the combined effort of the authors listed above
Director Name: Joseph E. Losee, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background
Velopharyngeal insufficiency (VPI) affects up to 1/3 of patients following cleft palate repair. Correction using a posterior pharyngeal flap (PPF) has been shown to improve clinical speech symptomatology; however, PPFs can be complicated by hyponasality and obstructive sleep apnea (OSA). The goal of this study was to assess if speech outcomes revert following clinically indicated PPF takedown.
Methods
Our Cleft-Craniofacial Database was retrospectively queried to identify patients with a diagnosis of VPI treated with a PPF who ultimately required takedown. Using the Pittsburgh Weighted Speech Score (PWSS), pre-operative scores were compared to those following PPF takedown. Outcomes following different methods of PPF takedown (PPF takedown alone or PPF takedown with conversion to Furlow Palatoplasty), were stratified & cross-compared.
Results
64 patients underwent PPF takedown. Of these, 18 underwent PPF takedown alone, and 46 underwent PPF takedown with conversion to Furlow Palatoplasty. For patients undergoing PPF takedown alone, the mean pre-operative and post-operative PWSS was 3.83(Range:0.0-23.0)(SD: 6.13) and 4.11(Range:0.0-23.0)(SD: 5.31) respectively (p=0.89). The mean change in PWSS was 0.28(Range -9.0-7.0)(SD: 4.3). For patients undergoing takedown of PPF with conversion to Furlow Palatoplasty, the mean pre-operative and post-operative PWSS was 6.37(Range: 0-26)(SD: 6.70) and 3.11(Range:0.0-27.0)(SD:4.14) respectively (p<0.01). The mean change in PWSS was -3.26(Range:-23.0-4.0)(SD: 4.3). For all patients, the mean pre-operative PWSS was 5.66(Range: 0.0-26)(SD:6.60) and 3.39(Range 0.0-27)(SD:4.48) respectively (p <0.05). The mean change in PWSS was -2.26 (Range:-23.0-7)(SD:5.7).
Conclusions
While there is concern that PPF takedown may degrade speech, this study finds that takedown of PPF, when clinically indicated, does not cause clinically significant regression of speech.
