Outcomes of Sphincter Pharyngoplasty in the Cleft Population
| Autor: | Antonio Rampazzo, Francis Papay, Addison Barnett, Bahar Bassiri Gharb, Ritwik Grover |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Velopharyngeal Insufficiency Treatment outcome Population 03 medical and health sciences Postoperative Complications 0302 clinical medicine Velopharyngeal insufficiency Humans Medicine 030223 otorhinolaryngology education Sleep Apnea Obstructive education.field_of_study business.industry Sleep apnea 030206 dentistry General Medicine medicine.disease Otorhinolaryngologic Surgical Procedures respiratory tract diseases Surgery Cleft Palate Obstructive sleep apnea Treatment Outcome medicine.anatomical_structure Otorhinolaryngology Cleft palate repair Pharynx Sphincter business Cleft palate surgery |
| Zdroj: | Journal of Craniofacial Surgery. 29:908-913 |
| ISSN: | 1049-2275 |
| DOI: | 10.1097/scs.0000000000004289 |
| Popis: | Sphincter pharyngoplasty (SP) is becoming increasingly popular for correction of velopharyngeal insufficiency (VPI) after cleft palate repair because of high success rate, low incidence of postoperative obstructive sleep apnea (OSA), and ease of revision in case of failure. This study is a meta-analysis of SP outcomes, reasons for failure, and revision strategies.A comprehensive review of the literature on SP outcomes was conducted. Sphincter pharyngoplasty failure was defined as persistent hypernasality, incomplete velopharyngeal port (VP) closure on instrumental evaluation with concomitant VPI, or nonresolving hyponasality and/or OSA persisting3 months after surgery. Two-tailed paired Student t test was used to compare outcomes between syndromic versus nonsyndromic patients and preoperative versus postoperative OSA rates.Forty-four publications evaluating 2402 patients were included. Overall SP success rate was 78.4% (77.3% in nonsyndromic vs 84.8% in syndromic patients, P = 0.11). Overall primary revision rate was 17.8% (20% in nonsyndromic vs 15.4% in syndromic patients P = 0.97). Most failures (89.5%) manifested as persistent VPI with continued hypernasality requiring revision, whereas 10.5% of failures manifested as obstructive symptoms and/or severe hyponasality requiring revision. Causal factors of SP failure were the following: large central port (62.8%), dehiscence (15.5%), tight port (12.1%), and low-inset (9.7%). Primary revision success rate was 75.6%. Obstructive sleep apnea rates increased from 5.1% to 18.4% (P = 0.02).This study suggests that SP can resolve VPI in 78.4% of patients, which can be increased to 94.7% after one revision. Most failures are technique-dependent; therefore, there could be significant ground for improvement of outcomes. |
| Databáze: | OpenAIRE |
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