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Tissue Augmenting Palatoplasty for Salvage of Speech in Secondary Palate Repair

Erin Anstadt MD, Madeleine K. Bruce BA, Wendy Chen MD MS, Sean Herman MD, Fady Paul Marji MD, Miles J. Pfaff MD MHS, Matthew Ford CCC-SLP, Jesse Goldstein MD, Joseph Losee MD
UPMC
2021-01-31

Presenter: Erin Anstadt

Affidavit:
Vu Nguyen

Director Name: Vu Nguyen

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial

Background:
Persistent velopharyngeal insufficiency (VPI) following primary palatoplasty has traditionally been treated with pharyngoplasty; however, the procedure is not without complications. This study evaluates speech outcomes following secondary palate repair via revision Furlow palatoplasty with tissue augmentation using buccal myomucosal flaps with or without buccal fat flaps (Tissue Augmenting Palatoplasty [TAP]) as an alternative to pharyngoplasty.

Methods:
Pediatric patients with a history of previous palatoplasty, a diagnosis of persistent or recurrent VPI and comprehensive pre- and postoperative speech evaluations who underwent TAP were included. Speech outcomes were assessed using perceptual speech assessments and Pittsburgh Weighted Speech Score (PWSS). Two-tailed Student's t test was performed and a p ≤ 0.05 was considered statistically significant. Mean standard deviation was reported.

Results:
Ten patients were included. There was a statistically significant improvement of PWSS following TAP; preoperative PWSS was 13.8 6.3, postoperative PWSS at most recent assessment was 4.60 4.4, p<0.001. Mean follow-up time was 11.1months.

Preoperatively, all patients were recommended for further speech surgery; 8 had VPI and 2 had borderline velopharyngeal function. Following TAP, no patients were recommended for pharyngoplasty. Two patients demonstrated persistent VPI, speech therapy alone was recommended. This represents a statistically significant improvement in the frequency of VPI within the cohort (Fisher's exact test, p=0.01) following TAP.

Conclusion:
In patients with VPI following primary palatoplasty, TAP offers an alternative to pharyngoplasty. This approach enables dynamic velopharyngeal function to improve speech outcomes and should be considered an option for patients with post-primary palatoplasty VPI.

Author Contact Information:
Erin Anstadt
4401 Penn Avenue
Pittsburgh, Pennsylvania
15224

4126925323
412-692-5323 (cell)

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