We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients
Objectives/Hypothesis To find an anatomical measurement of the cleft palate (or a calculated parameter) that predicts the occurrence of velopharyngeal insufficiency (VPI) after palatal cleft repair. Study Design Retrospective cohort study. Methods Charts were reviewed from cleft palate patients who...
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| Veröffentlicht in: | The Laryngoscope 2014-02, Vol.124 (2), p.561-569 |
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| creator | Leclerc, Jacques E. Godbout, Audrey Arteau-Gauthier, Isabelle Lacour, Sophie Abel, Kati McConnell, Élisa-Maude |
| description | Objectives/Hypothesis
To find an anatomical measurement of the cleft palate (or a calculated parameter) that predicts the occurrence of velopharyngeal insufficiency (VPI) after palatal cleft repair.
Study Design
Retrospective cohort study.
Methods
Charts were reviewed from cleft palate patients who underwent palatoplasty by the Von Langenbeck technique for isolated cleft palate or Bardach two‐flap palatoplasty for cleft lip‐palate. Seven anatomical cleft parameters were prospectively measured during the palatoplasty procedure. Three blinded speech–language pathologists retrospectively scored the clinically assessed VPI at 4 years of age. The recommendation of pharyngoplasty was also used as an indicator of VPI.
Results
From 1993 to 2008, 67 patients were enrolled in the study. The best predicting parameter was the ratio a/(30 − b1), in which a is defined as the posterior gap between the soft palate and the posterior pharyngeal wall and b1 is the width of the cleft at the hard palate level. An a/(30 − b1) ratio >0.7 to 0.8 is associated with a higher risk of developing VPI (relative risk = 2.2–5.1, sensitivity = 72%–81%, P |
| doi_str_mv | 10.1002/lary.24200 |
| format | Article |
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To find an anatomical measurement of the cleft palate (or a calculated parameter) that predicts the occurrence of velopharyngeal insufficiency (VPI) after palatal cleft repair.
Study Design
Retrospective cohort study.
Methods
Charts were reviewed from cleft palate patients who underwent palatoplasty by the Von Langenbeck technique for isolated cleft palate or Bardach two‐flap palatoplasty for cleft lip‐palate. Seven anatomical cleft parameters were prospectively measured during the palatoplasty procedure. Three blinded speech–language pathologists retrospectively scored the clinically assessed VPI at 4 years of age. The recommendation of pharyngoplasty was also used as an indicator of VPI.
Results
From 1993 to 2008, 67 patients were enrolled in the study. The best predicting parameter was the ratio a/(30 − b1), in which a is defined as the posterior gap between the soft palate and the posterior pharyngeal wall and b1 is the width of the cleft at the hard palate level. An a/(30 − b1) ratio >0.7 to 0.8 is associated with a higher risk of developing VPI (relative risk = 2.2–5.1, sensitivity = 72%–81%, P < .03).
Conclusions
The width of the cleft at the hard palate level and the posterior gap between the soft palate and the posterior pharyngeal wall were found to be the most significant parameters in predicting VPI. The best correlation was obtained with the ratio a/(30 − b1).
Level of Evidence
4 Laryngoscope, 124:561–569, 2014</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1002/lary.24200</identifier><identifier>PMID: 23686336</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Body Weights and Measures ; Child, Preschool ; Cleft palate ; Cleft Palate - surgery ; Cohort Studies ; Female ; Humans ; hypernasality ; Male ; Palate - pathology ; Palate - surgery ; palatoplasty ; pharyngoplasty ; Postoperative Complications - etiology ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; velopharyngeal dysfunction ; velopharyngeal insufficiency ; Velopharyngeal Insufficiency - etiology</subject><ispartof>The Laryngoscope, 2014-02, Vol.124 (2), p.561-569</ispartof><rights>Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3600-f94a58126c19747f18abfcde976b4cb507de1e212bac5fd800231c685273e1aa3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flary.24200$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flary.24200$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23686336$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leclerc, Jacques E.</creatorcontrib><creatorcontrib>Godbout, Audrey</creatorcontrib><creatorcontrib>Arteau-Gauthier, Isabelle</creatorcontrib><creatorcontrib>Lacour, Sophie</creatorcontrib><creatorcontrib>Abel, Kati</creatorcontrib><creatorcontrib>McConnell, Élisa-Maude</creatorcontrib><title>We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients</title><title>The Laryngoscope</title><addtitle>The Laryngoscope</addtitle><description>Objectives/Hypothesis
To find an anatomical measurement of the cleft palate (or a calculated parameter) that predicts the occurrence of velopharyngeal insufficiency (VPI) after palatal cleft repair.
Study Design
Retrospective cohort study.
Methods
Charts were reviewed from cleft palate patients who underwent palatoplasty by the Von Langenbeck technique for isolated cleft palate or Bardach two‐flap palatoplasty for cleft lip‐palate. Seven anatomical cleft parameters were prospectively measured during the palatoplasty procedure. Three blinded speech–language pathologists retrospectively scored the clinically assessed VPI at 4 years of age. The recommendation of pharyngoplasty was also used as an indicator of VPI.
Results
From 1993 to 2008, 67 patients were enrolled in the study. The best predicting parameter was the ratio a/(30 − b1), in which a is defined as the posterior gap between the soft palate and the posterior pharyngeal wall and b1 is the width of the cleft at the hard palate level. An a/(30 − b1) ratio >0.7 to 0.8 is associated with a higher risk of developing VPI (relative risk = 2.2–5.1, sensitivity = 72%–81%, P < .03).
Conclusions
The width of the cleft at the hard palate level and the posterior gap between the soft palate and the posterior pharyngeal wall were found to be the most significant parameters in predicting VPI. The best correlation was obtained with the ratio a/(30 − b1).
Level of Evidence
4 Laryngoscope, 124:561–569, 2014</description><subject>Body Weights and Measures</subject><subject>Child, Preschool</subject><subject>Cleft palate</subject><subject>Cleft Palate - surgery</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>hypernasality</subject><subject>Male</subject><subject>Palate - pathology</subject><subject>Palate - surgery</subject><subject>palatoplasty</subject><subject>pharyngoplasty</subject><subject>Postoperative Complications - etiology</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>velopharyngeal dysfunction</subject><subject>velopharyngeal insufficiency</subject><subject>Velopharyngeal Insufficiency - etiology</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkctOwzAQRS0EglLY8AEoEhs2AT9iO1ki3lIFUtXyWFmOM4EUNwlxAuTvcSh0wWps3XM9vjMIHRB8QjCmp1Y3_QmNKMYbaEQ4I2GUJHwTjbzIwpjTpx2069wCYyIZx9tohzIRC8bECM0fITC6DOoGssK0QV25ttZWt1VttWv74ANsVb_6DuULaBsUpevyvDAFlKb3t8BYyL1tsIAvrRdat4e2cm0d7P_WMZpfXc7Ob8LJ_fXt-dkkNExgHOZJpHlMqDAkkZHMSazT3GSQSJFGJuVYZkCAEppqw_MsHvIQI3wiyYBozcboePVu3VTvHbhWLQtnwFpdQtU5RaKECplgxj169A9dVF1T-t8NFPbzSDj11OEv1aVLyFTdFEufXf0NzANkBXwWFvq1TrAaVqHsDzysQk3Ops8_J-8JV57CtfC19ujmTQnJJFePd9dqdjGVNw84UoR9A1_gi1I</recordid><startdate>201402</startdate><enddate>201402</enddate><creator>Leclerc, Jacques E.</creator><creator>Godbout, Audrey</creator><creator>Arteau-Gauthier, Isabelle</creator><creator>Lacour, Sophie</creator><creator>Abel, Kati</creator><creator>McConnell, Élisa-Maude</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201402</creationdate><title>We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients</title><author>Leclerc, Jacques E. ; Godbout, Audrey ; Arteau-Gauthier, Isabelle ; Lacour, Sophie ; Abel, Kati ; McConnell, Élisa-Maude</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3600-f94a58126c19747f18abfcde976b4cb507de1e212bac5fd800231c685273e1aa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Body Weights and Measures</topic><topic>Child, Preschool</topic><topic>Cleft palate</topic><topic>Cleft Palate - surgery</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>hypernasality</topic><topic>Male</topic><topic>Palate - pathology</topic><topic>Palate - surgery</topic><topic>palatoplasty</topic><topic>pharyngoplasty</topic><topic>Postoperative Complications - etiology</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>velopharyngeal dysfunction</topic><topic>velopharyngeal insufficiency</topic><topic>Velopharyngeal Insufficiency - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leclerc, Jacques E.</creatorcontrib><creatorcontrib>Godbout, Audrey</creatorcontrib><creatorcontrib>Arteau-Gauthier, Isabelle</creatorcontrib><creatorcontrib>Lacour, Sophie</creatorcontrib><creatorcontrib>Abel, Kati</creatorcontrib><creatorcontrib>McConnell, Élisa-Maude</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leclerc, Jacques E.</au><au>Godbout, Audrey</au><au>Arteau-Gauthier, Isabelle</au><au>Lacour, Sophie</au><au>Abel, Kati</au><au>McConnell, Élisa-Maude</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients</atitle><jtitle>The Laryngoscope</jtitle><addtitle>The Laryngoscope</addtitle><date>2014-02</date><risdate>2014</risdate><volume>124</volume><issue>2</issue><spage>561</spage><epage>569</epage><pages>561-569</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><abstract>Objectives/Hypothesis
To find an anatomical measurement of the cleft palate (or a calculated parameter) that predicts the occurrence of velopharyngeal insufficiency (VPI) after palatal cleft repair.
Study Design
Retrospective cohort study.
Methods
Charts were reviewed from cleft palate patients who underwent palatoplasty by the Von Langenbeck technique for isolated cleft palate or Bardach two‐flap palatoplasty for cleft lip‐palate. Seven anatomical cleft parameters were prospectively measured during the palatoplasty procedure. Three blinded speech–language pathologists retrospectively scored the clinically assessed VPI at 4 years of age. The recommendation of pharyngoplasty was also used as an indicator of VPI.
Results
From 1993 to 2008, 67 patients were enrolled in the study. The best predicting parameter was the ratio a/(30 − b1), in which a is defined as the posterior gap between the soft palate and the posterior pharyngeal wall and b1 is the width of the cleft at the hard palate level. An a/(30 − b1) ratio >0.7 to 0.8 is associated with a higher risk of developing VPI (relative risk = 2.2–5.1, sensitivity = 72%–81%, P < .03).
Conclusions
The width of the cleft at the hard palate level and the posterior gap between the soft palate and the posterior pharyngeal wall were found to be the most significant parameters in predicting VPI. The best correlation was obtained with the ratio a/(30 − b1).
Level of Evidence
4 Laryngoscope, 124:561–569, 2014</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>23686336</pmid><doi>10.1002/lary.24200</doi><tpages>9</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Body Weights and Measures Child, Preschool Cleft palate Cleft Palate - surgery Cohort Studies Female Humans hypernasality Male Palate - pathology Palate - surgery palatoplasty pharyngoplasty Postoperative Complications - etiology Predictive Value of Tests Prognosis Retrospective Studies velopharyngeal dysfunction velopharyngeal insufficiency Velopharyngeal Insufficiency - etiology |
| title | We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients |
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