Surgery for Velopharyngeal Insufficiency Following Cleft Palate Repair: An Audit of Contemporary Practice and Proposed Schema of Techniques and Variations.

Autor:	Tse RW; Craniofacial and Pediatric Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA.; Plastic Surgery, University of Washington, Seattle, WA, USA., Sie KC; Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA.; Otolaryngology Head and Neck Surgery, University of Washington, Seattle, WA, USA., Tollefson TT; Otolaryngology Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA., Jackson OA; Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Kirshner R; Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.; Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA., Fisher DM; Plastic Surgery, The Hospital for Sick Children, Toronto, ON, USA.; Plastic Surgery, University of Toronto, Toronto, ON, USA., Bly R; Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA.; Otolaryngology Head and Neck Surgery, University of Washington, Seattle, WA, USA., Arneja JS; Plastic Surgery, BC Children's Hospital, Vancouver, BC, USA.; Plastic Surgery, University of British Columbia, Vancouver, BC, USA., Dahl JP; Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA.; Otolaryngology Head and Neck Surgery, University of Washington, Seattle, WA, USA., Soldanska M; Plastic Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA., Sitzman TJ; Plastic Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.; Plastic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
Jazyk:	angličtina
Zdroj:	The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association [Cleft Palate Craniofac J] 2024 Oct; Vol. 61 (10), pp. 1721-1734. Date of Electronic Publication: 2023 Jul 13.
DOI:	10.1177/10556656231181359
Abstrakt:	Objective: Surgical treatment of velopharyngeal insufficiency (VPI) includes a wide array of procedures. The purpose of this study was to develop a classification for VPI procedures and to describe variations in how they are performed. Design/participants/setting/outcomes: We completed an in-depth review of the literature to develop a preliminary schema that encompassed existing VPI procedures. Forty-one cleft surgeons from twelve hospitals across the USA and Canada reviewed the schema and either confirmed that it encompassed all VPI procedures they performed or requested additions. Two surgeons then observed the conduct of the procedures by surgeons at each hospital. Standardized reports were completed with each visit to further explore the literature, refine the schema, and delineate the common and unique aspects of each surgeon's technique. Results: Procedures were divided into three groups: palate-based surgery; pharynx-based surgery; and augmentation. Palate-based operations included straight line mucosal incision with intravelar veloplasty, double-opposing Z-plasty, and palate lengthening with buccal myomucosal flaps. Many surgeons blended maneuvers from these three techniques, so a more descriptive schema was developed classifying the maneuvers employed on the oral mucosa, nasal mucosa, and muscle. Pharynx-based surgery included pharyngeal flap and sphincter pharyngoplasty, with variations in design for each. Augmentation procedures included palate and posterior wall augmentation. Conclusions: A comprehensive schema for VPI procedures was developed incorporating intentional adaptations in technique. There was substantial variation amongst surgeons in how each procedure was performed. The schema may enable more specific evaluations of surgical outcomes and exploration of the mechanisms through which these procedures improve speech. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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