Criteria for early and late velopharyngoplasty in 61 children with cleft palate - 12/03/22

Doi : 10.1016/j.jormas.2022.03.003

Estelle Sanquer ^a,^b, Quentin Hennocq ^a,^b, Arnaud Picard ^a,^b,^c, Alexandra Bucur-Girard ^a,^b, Natacha Kadlub ^a,^b,^c,^⁎ , Cécilia Neiva-Vaz ^a,^b
^a Department of Maxillo-facial and Plastic Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
^b facial cleft and malformation national network, Paris, France
^c University of Paris, France

^⁎Corresponding author at: Service de Chirurgie Maxillo-faciale et Chirurgie Plastique, Hôpital Necker-Enfants Malades, 146 rue de Sèvres, 75015 Paris, France.Service de Chirurgie Maxillo-faciale et Chirurgie PlastiqueHôpital Necker-Enfants Malades146 rue de SèvresParis75015France

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Saturday 12 March 2022
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Abstract

Background

Velopharyngeal insufficiency persists in 15 to 30% of children with cleft palate, despite early velar surgery. Pharyngoplasty using a superior pedicle flap is the most common secondary surgery to treat velopharyngeal insufficiency. This study aims to identify the criteria leading to indicate velopharyngoplasty in 3 groups of age.

Materials and methods

we conducted a retrospective single center study in the reference center for cleft palate in Paris from 2013 to 2016. We included 61 children with non-syndromic cleft operated on with a velopharyngoplasty for velopharyngeal insufficiency. Pre-operative speech and surgical assessments, as well as the operative reports of the children, were analyzed retrospectively using multivariate models.

Results

We included 61 patients. The only criteria factor for an early velopharyngoplasty was the Pittsburgh Weighted Speech Scale (PWSS) score (OR 1.20, CI 95% 1.07 to 1.4 ; P=.006). Criteria for a late velopharyngoplasty were a degradation of the velopharyngeal function (OR 16.07, CI 95% 1.7 to 518.7 ; P=.041) and lost of follow-up (OR 5.78, CI 95% 3.9 to 4320 ; P=.017).

Conclusion

Criteria for early and late velopharyngoplasty were identified, and we demonstrated the insufficiency of Borel-Maisonny classification for scientific clinical study.

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Keywords : Velopharyngeal insufficiency, Indication criteria, Velopharyngoplasty, Cleft palate, Secondary surgery