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Objectives

Adenoidectomy is indicated for the relief of paediatric nasal obstruction, sleep-disordered breathing and otitis media with effusion (OME). Velopharyngeal insufficiency (VPI) is a rare complication. The main risk factor is the presence of pre-existing velopharyngeal closure-impaired mechanisms, including submucosal or overt cleft palate. Despite possible benefits, adenoidectomy is frequently withheld in such children to avoid VPI. This study aims to demonstrate the efficacy and safety of partial adenoidectomy using suction diathermy in children who previously underwent overt cleft palate repair during infancy, to allow selective resection of tissue and symptom resolution without producing VPI.

Methods

Since 1994, 18 patients with previously corrected overt cleft palate have undergone partial adenoidectomy at this centre, for the treatment of nasal obstruction or sleep-disordered breathing, with or without OME. Three had existing VPI following their cleft correction surgery. Selective resection of the adenoid was performed transorally under indirect vision, using a malleable suction coagulator. This allowed exposure of the posterior choanae, leaving the remaining adenoid bulk intact.

Results

Patients were followed up at 4 weeks, and subsequently at regular intervals (total follow up 30-180 months, median 92 months), including perceptual speech assessment in all cases. All demonstrated symptomatic improvement with respect to the original indications for surgery. None developed worsening hypernasal speech or other features of VPI, and there were no cases of symptomatic adenoidal re-growth.

Conclusions

Partial adenoidectomy, employing a variety of methods, has been used successfully in children with submucosal cleft palate. This study demonstrates the safe and effective use of suction diathermy to enable partial adenoidectomy in children who have previously undergone surgical correction of overt cleft palate, allowing symptom resolution without producing VPI.  相似文献   

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The incidences of otitis media with effusion (OME), otoscopic findings of the ear drum, hearing acuity and tympanometric findings were evaluated in 56 cases of cleft palate (CP), 33 cases of submucous cleft palate (SMCP) and 25 cases of congenital velopharyngeal insufficiency without cleft (CVPI). In all the cases, the incidences of OME, the pathological findings in otoscopy and the hearing test were far poorer in the group 8 years old and up than in the younger group. In the younger age group, the incidence of OME was 69% among the CP group, 62% in the SMCP group and showed significantly less incidence in the CVPI group (28%). The incidence of pathological findings in the ear drum was significantly less in the CVPI group than in either the CP group or the SMCP group. Hearing impairment was more frequent in the CP group than in both the SMPC and CVPI groups, while fewer incidences of abnormal tympanogram were found in the CVPI group than in the other two groups. Nearly 14% of the younger CP group developed pathological findings after surgery for velopharyngeal improvement. Most cases were found after push back operations, but rare after pharyngeal flap operations.  相似文献   

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22q11.2 microdeletion syndrome (22q11.2DS) is the most common syndrome associated with cleft palate and velopharyngeal insufficiency (VPI). Over 180 clinical features have been described. Most common features include: cardiac malformations, cleft palate, velopharyngeal insufficiency, characteristic facial features, hypotonia, behavioral disorders, and musculoskeletal disorders among several other fenotipical features. A case of 22q11.2DS confirmed by cytogenomic analysis is presented with review of the literature. Main clinical features were a submucous cleft palate (SMCP) with persistent VPI after palatoplasty, an ectopic left internal carotid artery and a prominent aortic root. VPI was corrected with a pharyngeal flap, tailored according to findings of videonasopharyngoscopy, videofluoroscopy and neck CT scan with contrast.  相似文献   

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Seventy-three children with submucous cleft palate (34 girls and 39 boys) with a mean age of 6.2 years (range 5.5–7.5) were compared retrospectively from lateral cephalograms. Thirty of the patients were not operated on, while 43 had had either palatal closure (n=13, mean age at operation: 1.7 years, range 0.8–3.9) or velopharyngeal flap (VPP) surgery (n=30, mean age at operation 3.7 years, range 1–6.8). There were no significant differences in the pharyngeal dimensions between girls and boys or patients without surgery and with palatal repair. Patients who had had VPP had the largest sagittal depths of the nasopharyngeal airway and smallest sagittal depths of the oropharyngeal airway. VPP in childhood was associated with narrowing of the lower pharyngeal airway.  相似文献   

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Introduction

The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up.

Objective

To evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency.

Methods

Patients with repaired cleft palate (± lip) who were submitted to surgical correction of velopharyngeal insufficiency using the bilateral buccinator myomucosal flap were assessed. Hypernasality (scores 0 [absent], 1 [mild], 2 [moderate], or 3 [severe]) was analyzed by three evaluators by measuring the audiovisual records collected in early and late preoperative and postoperative periods (3 and 12 months, respectively). The values were considered significant for a 95% Confidence Interval (p < 0.05).

Results

Thirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Analyses of the late postoperative period showed that hypernasality (0.5 ± 0.7) was significantly (p < 0.05) lower than the hypernasality of the preoperative and recent postoperative periods (2.8 ± 0.4 and 1.7 ± 0.9, respectively).

Conclusion

The buccinator myomucosal flap is effective in reducing/eliminating hypernasality in patients with cleft palate (± lip) and velopharyngeal insufficiency.  相似文献   

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The association between velopharyngeal function, craniofacial morphology and adenoidectomy was investigated using 27 craniofacial and nasopharyngeal variables taken from lateral cephalograms. The sample consisted of 96 boys with cleft palates with or without cleft lips. They were examined at 6 years of age when cephalograms were obtained and perceptual speech assessments were performed. The subjects were divided into three groups: (1) velopharyngeal competence (VPC, n = 45); (2) mild incompetence not requiring velopharyngoplasty (VPI, n = 36); and (3) previous incompetence operated on with velopharyngoplasty ad modum Hoenig (VPP, n = 15) before the 6-year examination. The groups were further divided into two subgroups according to previous adenoidectomy (Ad+, Ad–). The cranial base, size and interrelationship of the maxilla and mandible and their relationship to the cranial base or the bony nasopharynx did not differ among the VPC, VPI and VPP groups. The sagittal depth of the nasopharyngeal airway (Pm-ad1, Pm-ad2, Pm-ad3) was significantly wider in the VPP group than in the the VPC and VPI groups. The previous adenoidectomy decreased the thickness of the posterior pharyngeal wall (ad1-Ba, ad2-so) and thus increased airway size. The length of the velum did not differ between the three groups or their subgroups with and without adenoidectomy. The results showed that adenoidectomy is a risk to velopharyngeal function by widening the nasal airway, but velopharyngeal incompetence cannot definitely be attributed to adenoidectomy. Received: 3 July 2001 / Accepted: 28 August 2001  相似文献   

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Objectives

To investigate age of diagnosis, typical symptoms, finding of the palate, therapy options and accompanying diseases.

Methods

A retrospective analysis of 439 patients with symptomatic submucous cleft palate (SMCP), who received a veloplasty operation (butterfly suture technique developed by Haase) was made.

Results

SMCP was initially diagnosed at the mean age of 4.9 years. Main symptoms were hyper nasal speech (51%) and conductive hearing loss (45%), which resolved after veloplasty (often in combination with adenotomy and insertion of ventilation tubes). Typical findings of the palate were a lack of posterior nasal spine (68%) and bifid uvula (59%). Following surgery 17.1% required speech therapy and 5.5% needed velopharyngoplasty due to continuing hyper nasal speech.

Conclusion

SMCP is often diagnosed very late, though symptoms of velopharyngeal insufficiency (hyper nasal speech, Eustachian tube dysfunction) and bifid uvula are present. We therefore recommend that all patients with such findings are examined by an appropriate specialist such as Phoniatrics, Otolaryngologist and Oral-Maxillofacial-Surgeon so that early diagnosis and palatoplasty can be performed. The veloplasty operation (butterfly suture technique) can be recommended as a safe therapy for velopharyngeal insufficiency for patients with symptomatic SMCP.  相似文献   

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This study was designed as a partial test of a previously hypothesized model for a subgroup of cleft speakers who show marginal velopharyngeal competence during speech. Specifically, speakers in the model were hypothesized to show minimal but consistent nasalization of speech by several criteria. Fifty-two subjects were selected because they met one of the criteria for the model, lateral x-ray films on /s/ that showed touch closure or a small velopharyngeal opening. The subjects were then examined by the other five criteria used for defining the hypothesized model, and were found to meet, in the majority, fewer than three. These findings indicates that lateral x-ray films are not sufficient for identifying this diagnostic subgroup, if it exists. Another possible conclusion is that the model proposed is too simplistic and that cleft palate speakers with marginal velopharyngeal competency typically show more variability in speech performance than was originally implied in the model.  相似文献   

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Otitis media is almost universal in cleft palate patients, at least during infancy. A lesser cleft manifestation, the occult submucous cleft palate, is identifiable in living patients by surgical dissection or flexible fiberoptic nasopharyngoscopy. We addressed the hypothesis that an even more subtle form of submucous cleft palate, involving both an abnormal musculus levator veli palatini and an abnormal musculus uvulae, is associated with otitis media. We studied 35 adult human cadaver specimens for histologic and infrared photographic transillumination evidence of what we have identified as the minuscule submucous cleft palate. None of the specimens had evidence of clinical otitis media, or clinical abnormality of the palate. Approximately one fifth of the specimens had evidence of minuscule submucous cleft palate: minimal bulk of the musculus uvulae and haphazard organization of the fibers of the musculus levator veli palatini. These data support the nasopharyngoscopic inference that in occult submucous cleft palate, there is both hypoplasia of the musculus uvulae and abnormal orientation of the fibers of the musculus levator veli palatini. Although not significant statistically, a trend was suggested for minuscule submucous cleft palate to be associated with indicators of prior otitis media.  相似文献   

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OBJECTIVE: To determine if quality of life (QOL) is affected in children with velopharyngeal insufficiency (VPI). DESIGN: Interview and survey. SETTING: Two university pediatric ambulatory centers. PARTICIPANTS: This population-based sample included 58 children, aged 5 to 17 years, and their parents; 29 of the children were diagnosed as having VPI and 29 were age-matched normal controls. INTERVENTION: Each participant (child and parent) completed 2 questionnaires: the Velopharyngeal Insufficiency Quality of Life (VPIQL), an instrument specifically designed for children with VPI, and the Pediatric Quality of Life Inventory, version 4.0 (PedsQL(4.0)), a standardized generic assessment instrument that systematically assesses the perception of health-related QOL in pediatric patients with chronic health conditions. MAIN OUTCOME MEASURES: The VPIQL questionnaire assessed patients' and parents' perceptions of speech, swallowing, situational and emotional difficulty, activity limitations, and perception of the patient by others. Caregiver impact was also assessed in the parent version of the VPIQL. RESULTS: The patients with VPI and their parents perceived a more statistically significant negative QOL compared with the normal controls and their parents in all domains of the VPIQL and the PedsQL(4.0). The parents of the children with VPI perceived a more negative emotional impact (P = .02), greater speech limitations (P = .05), and fewer swallowing problems (P<.001) compared with their children. CONCLUSIONS: Children with VPI and their parents perceive negative QOL greater than that of normal controls and their parents. Parental proxy may be an adequate substitute in this population.  相似文献   

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Objective

The objective of this review is to summarize all aspects of middle ear diseases in children with cleft palate (CP).

Methods

PubMed, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and The Cochrane Library were searched for English-language randomized control trials (RCTs), meta-analyses, systematic reviews and observational studies published through 31st July 2017.

Results

Epidemiology and pathogenesis of middle ear diseases in children with cleft palate have been discussed in this review. Methods of Evaluation, CP surgeries, complications and follow up have been detailed for the same.

Conclusion

Evaluation of middle-ear disease in children with CP begins at birth by a newborn hearing screen. Tympanometry and otoscopy helps screen for middle-ear disease during follow-up visits. Ventilation tube may be placed when indicated based on the patient’s clinical course and presentation. Long-term follow up should be provided to look for the development of cholesteatoma.  相似文献   

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