Speech Outcomes Following Orticochea Pharyngoplasty in Patients With History of Cleft Palate and Noncleft Velopharyngeal Dysfunction.

OBJECTIVE: To report speech outcomes following Orticochea pharyngoplasty in 43 patients with cleft palate and noncleft velopharyngeal dysfunction. DESIGN: A retrospective surgical audit of patients undergoing Orticochea pharyngoplasty between 2004 and 2012, with speech as a primary outcome measure. SETTING: Patients known to a regional UK cleft center. METHODS: Forty-three patients underwent Orticochea pharyngoplasty by a single surgeon in a UK regional cleft center. Twenty-one patients had undergone a prior procedure for velopharyngeal dysfunction. Pre- and postoperative speech samples were assessed blindly using the Cleft Audit Protocol for Speech-Augmented by a specialist cleft speech and language therapist, external to the team. Speech samples were rated on the following parameters: hypernasality, hyponasality, audible nasal emission, nasal, turbulence, and passive cleft speech characteristics. Statistical differences in pre- and postoperative speech scores were tested using the Wilcoxon matched-pairs signed-ranks test. Inter- and intrareliability scores were calculated using weighted Cohen κ. RESULTS: Whole group: A statistically significant difference in pre- and postoperative scores for hypernasality (P < .001), hyponasality (P < .05), nasal emission (P < .01), and passive cleft speech characteristics (P < .01) were reported. Patients with cleft diagnoses: A statistically significant difference in scores for hypernasality (P < .001), nasal emission (P < .01), and passive cleft speech characteristics (P < .01) were reported for this group of patients. Patients with noncleft diagnoses: The only parameter to demonstrate a statistically significant difference was hypernasality (P < .01) in this group. CONCLUSIONS: Orticochea pharyngoplasty is a successful surgical procedure in treating velopharyngeal dysfunction in both the cleft and noncleft populations.

Versatile applications of the polydioxanone plate in rhinoplasty and septal surgery.

BACKGROUND: Rhinoplasty and septal surgery often require the use of cartilage grafts. Autologous cartilage may be thin or deviated, and the use of an absorbable scaffold material to support the reimplanted cartilage during healing can improve technique and outcomes. OBJECTIVE: To describe the use of a polydioxanone plate not only as a template in extracorporeal septoplasty but also for various other grafts commonly used in rhinoplasty and for the repair of septal perforations. METHODS: A retrospective case note review was performed between November 1, 2007, and February 28, 2011, for all patients treated using a polydioxanone plate. Surgical outcomes are discussed. RESULTS: A polydioxanone plate was used in septal and/or rhinoplasty surgery in 102 patients treated during a 40-month period. Follow-up was 9 to 18 months (mean, 12 months), with 96 patients reporting a good cosmetic or functional result. Up to 15% of patients experienced temporary septal swelling, but there were only 2 postoperative infections and no other significant complications. CONCLUSIONS: The polydioxanone plate is a safe and reliable absorbable implant that has many different applications in rhinoplasty and septal surgery. It not only acts as a scaffold but also stimulates and guides cartilage regeneration.