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Diagnosis, Treatment, And Long-term Speech Outcomes Of Occult Submucous Cleft Palate-associated Velopharyngeal Insufficiency
Michael R Bykowski, Jack Brooker, Ian Chow, Jesse A Goldstein, Joseph E Losee
University of Pittsburgh
2017-02-15
Presenter: Michael R Bykowski
Affidavit:
This abstract represents the resident's work.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction
Occult submucous cleft palate (OSMCP) is often misdiagnosed and mismanaged with little available long-term speech outcome literature. The goal of this study is to report our experience with diagnosis, treatment, and long-term outcomes of OSMCP.
Methods
Records were retrospectively reviewed for patients with OSMCP who were surgically treated for velopharyngeal insufficiency (VPI) between September 2004 and September 2013. OSMCP was defined by the lack of zona pellucida, hard palate notching, and bifid uvula. Records with <3 years of clinical follow-up were excluded from analysis. The primary outcome was the requirement of secondary speech surgery.
Results
Long-term follow-up (mean= 5.5 years) was available for 41 patients who underwent Furlow palatoplasty to treat OSMCP and VPI (mean age= 6.7 years). OSMCP was diagnosed by a combination of techniques: 1) intraoral examination demonstrating vaulted V-shaped palatal elevation with gag (87.8%; 36/41 patients); 2) magnetic resonance imaging (19.5%; 8/41 patients); and 3) videofluoroscopy (65.8%; 27/41 patients). 39.0% of patients required secondary speech surgery due to persistent or re-development of VPI, which was performed an average of 2.96 years after initial palatoplasty (range: 1.02 – 5.71 years). Posterior pharyngeal flap (PPF) was performed in 87.5% of secondary cases, of which 14.2% developed obstructive sleep apnea and required PPF takedown.
Discussion
Furlow palatoplasty can achieve successful long-term speech outcomes in many patients with OSMCP-associated VPI. However, patients must be monitored over time for recurrence and need for secondary speech surgery. Importantly, Furlow palatoplasty can limit the risk of PPF-related obstructive sleep apnea.
