The Relationship between Age and Speech Improvement in the Patients Performed Pharyngeal Flap for Correction of Velopharyngeal Dysfunction

PURPOSE: The pharyngeal flap is one of the popular surgical methods to treat the problem of velopharyngeal dysfunction. This study evaluated speech outcome of patients who underwent superiorly based pharyngeal flap surgery based on timing of surgery. METHODS: A restrospective review of 50 patients who underwent pharyngeal flap surgery for velopharyngeal insufficiency from September 1996 to January 2008 was undertaken. Thirty patients with an available preoprative and postoperative speech assessments with at least 6 months of follow-up were included in this study. We checked out the significance of speech improvement after surgery analysing preoperative and postoperative scoring of speech assessment. We also investigated the direct relationship between the age at surgery and the degree of speech improvement, and the improvement score in different age groups. RESULTS: The mean score of preoperative speech was 52.6 +/- 7.4 points and postoperative speech was 58.6 +/- 6.5 points, which presented significant postoperative speech improvement with an average of 5.9 points (p<0.01). There was a significant inverse relationship between the age at operation and speech improvement degree (p<0.01, r=-0.54). Comparing the age groups, the age group of 4 to 5 years presented statistically significant speech improvement (p<0.01). CONCLUSION: we propose that all patients indicated should take pharyngeal flap irrespective of age. In this study, the younger the age at surgery, the higher degree of speech improvement, for which we suggest that surgical approach should be undertaken as early as possible, especially younger than 5 years of age.

Case reports of bone grafting in unilateral alveolar-palatal cleft patients / 영남의대학술지

We obtained successful functional and esthetic results by grafting of iliac marrow-cancellous bone in 2 cases of alveolar-palatal cleft patients. Bone graft of alveolar-palatal clefts provide bony support to adjacent teeth of cleft area, prevented from relapse of orthodontic arch expansion, closure of oroantral fistula and improvement of speech problem. 1. In one case, extraction of upper right central incisor that was little bone support, alignment of rotated teeth and expansion of collapsed arch segment were done with pre-orthodontic treatment. The other case. Bone grafting was done after removal of prosthesis with no pre-orthodontic treatment. 2. After mucoperiosteal incision in cleft area, the mucosal flap of labial area, palate and nose were separation and the raised nasal mucosa was sutured for closure of oroantral fistula. Then, the iliac marrow-cancellous bones were grafted to cleft site. 3. After 6 months of operation, we had seen the new bone deposition to cleft site in dental radiograph and prosthetic treatment of missing teeth were done.