The aim of this study was to review current literature regarding the speech outcome of different techniques of surgical treatment of VPD in cleft patients, in an attempt to reach a treatment algorithm.
Design: A systematic review was done, by searching Pubmed, Scopus and Web of Science electronic databases, following the PRISMA guidelines.
Participants: Articles reporting speech assessment results of secondary VPI surgeries on non- syndromic patients with CP.
Interventions: surgical techniques were categorized into two groups; palatal and pharyngeal surgeries.
Main outcome: Raw data was extracted to compare speech outcome and complication of each technique, with special emphasis on the factors affecting, the patients’ selection for each technique.
Our results showed comparable success and complication rates among these techniques. However, the factors governing selection of each technique, were identified and taken into consideration to reach a preliminary algorithm.
A preliminary treatment algorithm is described based on the results of our review; the most important factors affecting the technique choice are: VP gap size, LVP position, palatal mobility, palatal scarring, VP closure pattern and age of the patient.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to British Journal of Oral and Maxillofacial Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Kummer AW. Disorders of resonance and airflow secondary to cleft palate and/or velopharyngeal dysfunction. InSeminars in Speech and Language 2011 May (Vol. 32, No. 02, pp. 141-149). © Thieme Medical Publishers.
- Treatment of velopharyngeal incompetence by the Furlow Z-plasty.Annals of plastic surgery. 1995 Jan 1; 34: 23-26
- The effectiveness of the superiorly based pharyngeal flap in relation to the type of palatal defect and timing of the operation.Plastic and reconstructive surgery. 1988 Nov 1; 82: 760-764
- A comparison of speech results after the pharyngeal flap and the dynamic sphincteroplasty procedures.Annals of plastic surgery. 1991 May 1; 26: 441-443
- Palate re-repair revisited.The Cleft palate-craniofacial journal. 2002 May; 39: 295-307
- Double-opposing Z-palatoplasty for secondary surgical management of velopharyngeal incompetence in the absence of a primary Furlow palatoplasty.The Cleft Palate-Craniofacial Journal. 2015 Sep; 52: 517-524
- Contractility of sphincter pharyngoplasty: Relevance to speech outcomes.Canadian Journal of Plastic Surgery. 2013 Mar; 21: 15-18
- Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.Systematic reviews. 2015 Dec; 4: 1-9
- Methodological index for non-randomized studies (MINORS): development and validation of a new instrument.ANZ journal of surgery. 2003 Sep; 73: 712-716
- Cleft palate re-repair—a clinical and radiographic study of 32 consecutive cases.British journal of plastic surgery. 1994 Jan 1; 47: 406-410
- Results with Furlow palatoplasty in management of velopharyngeal insufficiency.Plastic and Reconstructive Surgery. 2001 Jul 1; 108: 17-25
- Bilateral buccinator myomucosal flap outcomes in nonsyndromic patients with repaired cleft palate and velopharyngeal insufficiency.Journal of Plastic, Reconstructive & Aesthetic Surgery. 2017 Nov 1; 70: 1598-1607
- Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip.Brazilian Journal of Otorhinolaryngology. 2018 Nov; 84: 697-707
- Aerodynamic and cephalometric analyses of velopharyngeal structure and function following re-pushback surgery for secondary correction in cleft palate.The Cleft palate-craniofacial journal. 2003 Jan; 40: 46-53
- Management of velopharyngeal insufficiency by modified Furlow palatoplasty with pharyngeal flap: a retrospective outcome review.International journal of oral and maxillofacial surgery. 2019 Jun 1; 48: 703-707
- Buccinator re-repair (Bs+ re: IVVP): a combined procedure to maximize the palate form and function in difficult VPI cases.The Cleft Palate-Craniofacial Journal. 2020 May; 57: 543-551
- Tailored posterior pharyngeal fat grafting outcomes in velopharyngeal insufficiency managed according to a simplified algorithm.Annals of Plastic Surgery. 2019 Aug 1; 83: 172-179
- Posterior pharyngeal fat grafting for velopharyngeal insufficiency.The Cleft Palate-Craniofacial Journal. 2013 Jan; 50: 51-58
- Speech evaluation for patients with cleft palate.Clinics in plastic surgery. 2014 Apr 1; 41: 241-251
- Autologous fat transplantation to the velopharynx for treating persistent velopharyngeal insufficiency of mild degree secondary to overt or submucous cleft palate.Journal of Plastic, Reconstructive & Aesthetic Surgery. 2013 Mar 1; 66: 337-344
- Minimal standards for reporting the results of surgery on patients with cleft lip, cleft palate, or both: a proposal.The Cleft Palate Journal. 1988 Jan 1; 25: 3-7
- The correction of velopharyngeal insufficiency by Furlow palatoplasty in patients older than 3 years undergoing Veau-Wardill-Kilner palatoplasty: a prospective clinical study.Plastic and Reconstructive Surgery. 2005 Jul 1; 116: 85-93
- Furlow palatoplasty for previously repaired cleft palate with velopharyngeal insufficiency.International journal of pediatric otorhinolaryngology. 2015 Oct 1; 79: 1748-1751
- Treatment of velopharyngeal insufficiency after cleft palate repair depending on the velopharyngeal closure pattern.Journal of Craniofacial Surgery. 2011 May 1; 22: 813-817
- Palatopharyngeal sling: a new technique in treatment of velopharyngeal insufficiency.International journal of pediatric otorhinolaryngology. 2008 Feb 1; 72: 173-177
- Improvement of quality of speech in patients with velo-pharyngeal insufficiency corrected using a buccinator myomucosal flap.Ceylon Medical Journal. 2016 Oct 3; 61
- Outcome of palate re-repair with radical repositioning of the levator muscle sling as a first-line strategy in postpalatoplasty velopharyngeal incompetence management protocol.Plastic and Reconstructive Surgery. 2018 Apr 1; 141: 984-991
- The quantitative evaluation of palatal elongation after Furlow palatoplasty.Journal of oral and maxillofacial surgery. 2004 Apr 1; 62: 446-450
- Experience with the Furlow double-reversing Z-plasty for cleft palate repair.Plastic and reconstructive surgery. 1986 Apr 1; 77: 569-576
- Correction of velopharyngeal insufficiency with Furlow palatoplasty.Archives of Otolaryngology-Head & Neck Surgery. 1996 Aug 1; 122: 881-884
- Double-opposing Z-plasty for secondary surgical management of velopharyngeal insufficiency following primary furlow palatoplasty.The Cleft Palate-Craniofacial Journal. 2018 May; 55: 706-710
- Outcomes of sphincter pharyngoplasty and palatal lengthening for velopharyngeal insufficiency: a 10-year experience.Archives of Otolaryngology-Head & Neck Surgery. 2011 Aug 15; 137: 763-766
- Outcomes of combined Furlow palatoplasty and sphincter pharyngoplasty for velopharyngeal insufficiency.Otolaryngology-Head and Neck Surgery. 2014 Feb; 150: 216-221
- Correction of secondary velopharyngeal insufficiency in cleft palate patients with the Furlow palatoplasty.Plastic and reconstructive surgery. 1994 Dec 1; 94: 933-941
- Results with Furlow palatoplasty in the management of velopharyngeal insufficiency.Plastic and reconstructive surgery. 2002 Jun 1; 109: 2588-2589
- Gross unilateral abnormalities of the velum and pharynx.The Cleft palate-craniofacial journal. 2002 Jul; 39: 461-468
- Sphincter pharyngoplasty as a treatment of velopharyngeal incompetence in young people: a prospective evaluation of effects on sleep structure and sleep respiratory disturbances.Chest. 2004 Mar 1; 125: 864-871
- Evaluation of the sphincter pharyngoplasty.The Cleft palate-craniofacial journal. 1992 May; 29: 254-261
- Tailoring velopharyngeal surgery: the influence of etiology and type of operation.Plastic and reconstructive surgery. 1994 Apr 1; 93: 948-953
- Does velopharyngeal closure pattern affect the success of pharyngeal flap pharyngoplasty?.Plastic and reconstructive surgery. 2005 Jan 1; 115: 45-52
Accepted: March 1, 2023
Received: December 31, 2022
Publication stageIn Press Accepted Manuscript
© 2023 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.