Changes of postoperative velopharyngeal function in children with cleft palate under 5 years old / 华西口腔医学杂志

OBJECTIVE@#To demonstrate the regularity of velopharyngeal function recovery after primary cleft palatoplasty and its correlation with different surgical procedures, ages, cleft types, and follow-up times.@*METHODS@#Patients with cleft palate under 5 years old who had more than two follow-up records were included in this study, and consecutive evaluations of postoperative velopharyngeal function were performed. Univariate and multivariate logistic regression analysis were used to reveal the regularity of postoperative velopharyngeal function and the possible influencing factors.@*RESULTS@#A total of 165 patients were included. Inconsistent functions of the velopharyngeal closure were observed in 31 patients, of which velopharyngeal insufficiency (VPI) in the first follow-up converted to velopharyngeal competence (VPC) in the second follow-up, accounting for 18.79% of the total, and 134 patients had consistent velopharyngeal function. The patients in the group who had consistent velopharyngeal function were younger than those in the group who were inconsistent, and the differences between the two groups were statistically significant. The younger the operation age, the patient's velopharyngeal function was more likely to stabilize at the first follow-up. At the time of the first follow-up in 15, 28, and 40 months, the probability that the patients had stable postoperative velopharyngeal function was 80%, 90%, and 95%, respectively.@*CONCLUSIONS@#The recovery of velopharyn-geal function after surgery is a dynamic process. The velopharyngeal status of patients can be converted from VPI to VPC. Meanwhile, VPC cannot switch to VPI. The follow-up time is the most important factor affecting the consistency of the evaluation of velopharyngeal function. Choosing appro-priate follow-up time is the key to obtain the stable evaluation of velopharyngeal function.

Individualized management of velopharyngeal insufficiency for cleft lip and palate / 中华整形外科杂志

Objective@#Velopharyngeal insufficiency (VPI) is a common postoperative sequela secondary tocleft palate. It could significantly impairpatients′living quality. Treatment of VPI includes surgery and speech therapy, but the reported success rates are inconsistent. A consensus in the literatures is needed, to guide procedure selection for patients with VPI.@*Methods@#This is a retrospective study on management options for patients with VPI.This study systematically introduces the assessment, management plan and treatment effect of VPI, in the Craniofacial center of Hospital Stomatology of Xi′an Jiaotong University.The challenges of VPI diagnosis and treatment with cleft palate are discussed in-depth.@*Results@#Most patients with VPI underwent evaluation and treatment (surgical or/and speech therapy) had speech improvement. The average value of hypernasality decreased from 3.67 before interventions to 1.57 after interventions.A multidisciplinary team using multi-modal to evaluate velopharyngeal function and speech. All patients had no bleeding, would dehiscence or fistula postoperatively. The difficulty of stimulability test was significantly reduced. Fourteen patients completed speech therapy, with the averaged treatments period of 3 months.@*Conclusions@#Speech pathologist is the manager of speech rehabilitation of cleft palate patients with VPI. The operation skill plays a key role in the treatment of VPI. Detailed diagnostic information is important for performing excellent surgical techniques. The cooperation of surgeon and speech pathologist, could be helpful to achieve the final speech rehabilitation.

Morphological classification and velopharyngeal function analysis of submucous cleft palate patients / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To enhance the accuracy in diagnosis and management of submucous cleft palate via a thorough analysis of its anatomical and functional details.</p><p><b>METHODS</b>Two hundred seventy-six submucous cleft palate cases from 2008 to 2014 were retrospectively investigated. Subgroup analysis were performed on the basis of preoperative velopharyngeal function, palatal morphology, cleft lip concurrence, and patient motives for treatment.</p><p><b>RESULTS</b>Among the included cases, 96 (34.78%) were presented as velopharyngeal competence (VPC), 151 (54.71%) as velopharyngeal insufficiency (VPI), and 29 (10.51%) as marginal VPI (MVPI). Eighty cases (28.99%) also demonstrated cleft lip deformity, and 196 cases (71.01%) were merely submucous cleft palate. Compared with patients with submucous cleft palate only, those with cleft lips exhibited higher rates of complete velopharyngeal closure. The pathological spectrum of submucous cleft palate varied significantly. Only 103 (37.32%) cases met all the three diagnostic criteria proposed by Calnan.</p><p><b>CONCLUSIONS</b>Given that the velopharyngeal closure rate varies among the subgroups, the factors analyzed in this study should be considered in the personalized manage-ment of submucous cleft palate.</p>

Effects of Bulb Type Palatal Lift Prosthesis Therapy on Nasality and Velopharyngeal Function of Patients Following Palatoplasty / Oral Science International

In the present study, the effects of bulb type palatal lift prosthesis (bulb-PLP) therapy on nasality and velopharyngeal function (VPF) of patients with velopharyngeal incompetence (VPI) following palatoplasty were longitudinally assessed.The subjects included 18 patients (3 to 52 years of age) who had shown persistent VPI following palatoplasty and who had received bulb-PLP therapy. Nasality and VPF were assessed by perceptual voice analysis, nasometer test, blowing test, and cephalometric radiographic examination. Based on the outcomes of bulb-PLP therapy, the subjects were classified into two groups: the effective group and the ineffective group. Furthermore, the obturating and VPF-activating effects by bulb-PLP therapy were analyzed, and factors relating to different VPF activities were determined.All subjects achieved adequate VPF by wearing a bulb-PLP. After treatment, 10 patients (55.6%) achieved successful activation of VPF without bulb-PLP (the effective group), while persistent VPI remained in 8 patients (the ineffective group). The beginning-blowing ratio of the effective group was significantly greater than that of the ineffective group (P < 0.05) and the velopharyngeal distance (V-P distance) of the effective group tended to be smaller (P = 0.07). Regarding the shape of the bulb head, the angular type was dominant in the ineffective group, while the round type was dominant in the effective group.Bulb-PLP therapy was useful for providing adequate VPF activation. Possible signs of the subsequent effective activation of VPF are considered to be: 1) preexisting adequate VPF on blowing, 2) smaller V-P distance, and 3) synchronized palatopharyngeal movement.