Velopharyngeal Insufficiency In Children Research Articles

OPTIMIZATION OF POWER-ASSISTED ADENOIDECTOMY IN CHILDREN USING SHAVER TIPS OF VARIOUS MODIFICATION.

The aim: To study the efficacy of surgical treatment of patients with adenoid vegetations by implementing a differential method for choosing a tip for endo-scopic power-assisted adenoidectomy in children depending on dentition. Materials and methods: We investigated the presence of nasal air emissions in 127 children (2-12 years old) before and after the operation. We excluded 12 patients due to the presence of nasal air emission before the operation. All patients were divided in 2 groups: I - children with aging primary dentition (55 children), II- children with mixed dentition (60 children). Depending on tips, that were used for the operation, we divided patients into two subgroups: A - 40˚ and B- 60 ˚. Results: In 9,4% of patients have the presence of nasal air emissions before the operation. The use of 40˚ tips does not allow removal of lymphoid tissue in "hard-to-reach" areas of the nasopharynx (perichoanal and peritubular sections) in 30% of children with aging primary dentition and 42.9% with mixed dentition. Conclusions: The use 40˚ tips for the adenoidectomy is accompanied by a higher risk of velopharyngeal insufficiency in children with mixed dentition compared to children who underwent the intervention with a tip with a larger bending angle and a longer working part (60°). In patients with temporary dentition, it is recommended to use a standard tip for adenoidectomy, except when correction of tubal lymphoid tissue is planned (it is necessary to use a tip with a rotating window). In patients with mixed dentition, it is recommended to use a 60° tip.

Surgical Outcomes for the Treatment of Velopharyngeal Insufficiency in 22q11.2 Deletion Syndrome.

This study aimed to compare outcomes of concomitant palatoplasty and sphincter pharyngoplasty with pharyngeal flap and sphincter pharyngoplasty alone for the treatment of velopharyngeal insufficiency in patients with 22q11.2 deletion syndrome. Thirty-one cases were identified for inclusion in the study. Patients were separated into 3 surgical groups: combined palatoplasty and sphincter pharyngoplasty (n = 11), pharyngeal flap (n = 7), and sphincter pharyngoplasty (n = 13). Outcome measures included perceptual speech analyses, surgical complications, and revision rates. There were no differences in preoperative speech analysis scores (P = .31). The combined palatoplasty and sphincter pharyngoplasty procedure had similar speech outcomes compared to pharyngeal flap, and both were significantly better than sphincter pharyngoplasty alone. Complication rates (P = .61) and the need for revision surgery (P = .25) were similar among all 3 groups. Concomitant palatoplasty and sphincter pharyngoplasty may be an alternative treatment for velopharyngeal insufficiency in children with 22q11.2 deletion syndrome.

Morphology of the Musculus Uvulae In Vivo Using MRI and 3D Modeling Among Adults With Normal Anatomy and Preliminary Comparisons to Cleft Palate Anatomy.

To investigate the musculus uvulae morphology in vivo in adults with normal velopharyngeal anatomy and to examine sex and race effects on the muscle morphology. We also sought to provide a preliminary comparison of musculus uvulae morphology in adults with normal velopharyngeal anatomy to adults with repaired cleft palate. Three-dimensional magnetic resonance imaging data and Amira 5.5 Visualization Modeling software were used to evaluate the musculus uvulae in 70 participants without cleft palate and 6 participants with cleft palate. Muscle length, thickness, width, and volume were compared among participant groups. Analysis of covariance analysis did not yield statistically significant differences in musculus uvulae length, thickness, width, or volume by race or sex among participants without cleft palate when the effect of body size was accounted for. Two-sample t test revealed that the musculus uvulae in participants with repaired cleft palate is significantly shorter (P = .008, 13.65 mm vs 16.07 mm) and has less volume (P = .002, 51.08 mm3 vs 97.62 mm3) than participants without cleft palate. In adults with normal velopharyngeal anatomy, the musculus uvulae is a cylindrical oblong-shaped muscle lying on the nasal surface of the soft palate, with its greatest bulk located just nasal to the levator veli palatini muscle sling. In participants with repaired cleft palate, the musculus uvulae is substantially reduced in volume. This diminished muscle bulk located just at the point where the palate contacts the posterior pharyngeal wall may contribute to velopharyngeal insufficiency in children with repaired cleft palate.

Augmentation pharyngoplasty for treatment of velopharyngeal insufficiency in children: Results with injectable dextranomer and hyaluronic acid copolymer.

To evaluate the effectiveness, durability, and safety of a tissue filler (dextranomer and hyaluronic acid copolymer) when injected submucosally in the nasopharynx to treat velopharyngeal insufficiency (VPI) in pediatric patients. Retrospective case series. Charts were reviewed for all patients treated with injectable filler at a tertiary children's center for VPI from April 2010 through September 2013. Main outcome measures included perceptual speech assessments before and after the procedure, velopharyngeal gap size on nasendoscopy, and nasalance. Length of follow-up, length of surgery, hospital admission, and complications were also identified. After injection augmentation pharyngoplasty, 93% of patients had no or mild hypernasality, 83% had resolution of nasal grimace, and 96% had resolution of audible nasal emission. Complications were minor and included mucosal infection, neck pain, snoring, and obstructive sleep apnea. Use of injectable filler to augment the nasopharynx is an effective, minimally invasive therapy for small or moderate-sized velopharyngeal gaps, with shorter procedural times, easier recovery, and acceptable durability. 4 Laryngoscope, 126:S5-S13, 2016.

Revision rates and speech outcomes following pharyngeal flap surgery for velopharyngeal insufficiency.

Velopharyngeal insufficiency in children with cleft palate (and other causes) contributes to difficulty with communication and quality of life. The pharyngeal flap is a workhorse to address hypernasality and nasal air escape. However, there is a paucity of literature on the characteristics of cases that require revision. To measure the revision rate of pharyngeal flaps, compare the preperceptual and postperceptual speech scores, and identify the characteristics of those patients who required revision. A retrospective medical record review was completed for patients who underwent pharyngeal flap surgery from June 1, 2008, through January 31, 2013, at a tertiary academic center. Perceptual speech analyses and surgical revision rates. Perceptual speech patterns before and after surgery were compared using nasal air emission and resonance scores. The association between requiring revision surgery and covariates was analyzed using multivariable mixed-effects logistic regression. Sixty-one patients were identified, including 24 boys (39%) and 37 girls (61%). The mean (SD) patient age at the time of pharyngeal flap surgery was 8.2 (6.8) years (range, 3-55 years). Velopharyngeal insufficiency was associated with cleft palate in 51 patients (84%), and 17 patients (28%) had a syndrome. The mean (SD) time to surgery after the speech evaluation was 225 (229) days (range, 14-1341 days). The mean (SD) nasal air emission scores decreased by -1.1 (2.0 [1.1] preoperatively to 0.8 [1.1] postoperatively). The mean (SD) resonance score decreased by -1.5 (2.4 [1.1] preoperatively to 0.9 [1.1] postoperatively; P < .001). Flaps were revised in 12 patients (20%), including port revision in 9, complete flap revision in 2, and flap takedown in 1. The only covariate that was significantly associated with revision rates was increased age at surgery, which was associated with a higher probability of revision surgery (odds ratio, 1.31; 95% CI, 1.03-1.66; P = .04). Pharyngeal flap surgery, when appropriately selected, was effective at improving speech with a revision rate of 20%, which is comparable to previously published studies. Increased age at the time of the pharyngeal flap surgery was associated with an increased need for revision surgery, supporting evidence that cleft centers should encourage early childhood speech evaluations with consistent documentation and prompt treatment. 3.

Velopharyngeal insufficiency after adenotonsillectomy in children

Objective: To evaluate preoperative risk factors of velopharyngeal insufficiency (VPI) after adenotonsillectomy in children. Settings: Tertiary cares medical centres. Design: Retrospective study using patient’s charts review. The aim of this study is to look at the associated risk factors that may explain the presentation of VPI in children following adenotonsillectomy. Methods and Material: Retrospective chart review of 32 children presented with VPI following adenotosillectomy between January 1, 2008 and December 30, 2014 at Asser Central Hospital (ACH) and Abha Private Hospital (APH). The data collected included the total number of adenotonsillectomy cases, patient age at surgery, gender, date of surgery, indications and outpatient postoperative notes. Exclusion criteria included; patients older than 12 years, children diagnosed having velocardiofacial syndrome, submucous clefts and those who had follow up less than 6 months. Results: Total numbers of ten thousand and eighty adenotonsillectomy cases were done in 7 years period. Thirty-two patients (0.3%) presented with postoperative hypernasality and nasal regurgitation. The mean age was 6 years. Females were more predominant than males (21 F, 11 M). The most common indication for surgery was mouth breathing and snoring in 19 (59.38%) patients. Short soft palate was the main cause of VPI in 20 (62.50%) patients. Conclusions: Velopharyngeal Insufficiency, although uncommon, is a well-known complication of adenotosillectomy. Patients presenting with obstructive symptoms and signs of adenotonsillectomy in presence of short soft plate or deep pharyngeal wall should be counseled for possible development of postoperative VPI. Most of symptoms of postoperative VPI resolve spontaneously.

Evaluating velopharyngeal closure with real-time MRI

Sir, It was with great interest that we read the article titled “Feasibility study to assess clinical applications of 3T cine MRI coupled with synchronous audio recording during speech in evaluation of velopharyngeal insufficiency in children” by Sagar and Nimkin [1]. We believe dynamic real-time MRI will become a prevalent tool in studying velopharyngeal closure and, when associated with detailed anatomical scans, should provide added clinical information compared to the current imaging modalities, videofluoroscopy and nasendoscopy. In this regard, the authors must be commended for their detailed comparison of real-time MRI with those techniques. However, it is worth highlighting that contrary to what is stated in the article, many studies of velopharyngeal closure using real-time MRI have been published in the imaging literature, most of them with synchronised audio recording. Studies focussing specifically on velopharyngeal closure include but are not limited to those by Beer et al. [2], which compared the technique to X-ray videofluoroscopy, Bae et al. [3] at 3 T, and Scott et al. [4], which included data at both 1.5 and 3 T. The last two studies were carried out with simultaneous audio recording. There are far too many speech studies using real-time MRI to mention in a short letter, although the work conducted at the University of Southern California both on acquisition and analysis [5, 6] is worth highlighting. We strongly encourage the interested reader to refer to the recent review of the field [7]. When studying velopharyngeal closure, the dynamic frame rate is a key issue, and we are concerned that only two frames per second (fps) were used in the study by Sagar and Nimkin [1]. Although there is no doubt this is sufficient to study sustained phonation, it appears to be insufficient for speech studies. All the previously mentioned studies [2–6] were acquired at substantially faster rates (5–25 fps). In our clinical experience, for various speech samples in normal phonation all closure events are detected at rates around 10 fps [8]; however, some are already missed at 5 fps. A lower frame rate will increase both blurring and the number of missed closure events; it could potentially lead to an incorrect diagnosis of velopharyngeal insufficiency if closure is short and not sampled. Higher frame rates (e.g., 30 fps [9] or more than 100 fps [10]) are achievable and can be required for linguistics and co-articulatory events studies. However, they are obtained using non-cartesian acquisitions, which have been recently developed and are not necessarily available on standard scanners. Furthermore, they usually rely on delayed-reconstruction, which is a limiting factor to conduct an interactive clinical speech study as would be desirable for velopharyngeal closure assessment. Real-time MRI of speech is a very active field of research, and new publications in this area are a welcome addition to the body of knowledge. However, a consensus on best practise for acquisition methodology is still to emerge, and until such time, we would recommend newcomers to err on the side of caution and try to obtain the best spatial-temporal resolution compromise that can be achieved with their chosen acquisition method.

Feasibility study to assess clinical applications of 3-T cine MRI coupled with synchronous audio recording during speech in evaluation of velopharyngeal insufficiency in children.

In the past decade, there has been increased utilization of magnetic resonance imaging (MRI) in evaluating and understanding velopharyngeal insufficiency (VPI). To our knowledge, none of the prior studies with MRI has simultaneously linked the audio recordings of speech during cine MRI acquisition with the corresponding images and created a video for evaluating VPI. To develop an MRI protocol with static and cine sequences during phonation to evaluate for VPI in children and compare the findings to nasopharyngoscopy and videofluoroscopy. Five children, ages 8-16 years, with known VPI, who had previously undergone nasopharyngoscopy and videofluoroscopy, were included. MRI examination was performed on a 3-T Siemens scanner. Anatomical data was obtained using an isotropic T2-weighted 3-D SPACE sequence with multiplanar reformation capability. Dynamic data was obtained using 2-D FLASH cine sequences of the airway in three imaging planes during phonation. Audio recordings were captured by a MRI compatible optical microphone. All five cases had MRI and nasopharyngoscopy and four had videofluoroscopy performed. VPI was identified by MRI in all five patients. The location and severity of the velopharyngeal gap, closure pattern, velar size and shape and levator veli palatini (LVP) muscle were identified in all patients. MRI was superior in visualizing the integrity of the LVP muscle. MRI was unable to identify hemipalatal weakness in one case. In a case of stress-induced VPI, occurring only during clarinet playing, cine MRI demonstrated discordant findings of a velopharyngeal gap during phonatory tasks but not with instrument playing. Overall, there was satisfactory correlation among MRI, nasopharyngoscopy and videofluoroscopy findings. Cine MRI of the airway during speech is a noninvasive, well-tolerated diagnostic imaging tool that has the potential to serve as a guide prior to and after surgical correction of VPI. MRI provided superior anatomical detail of the levator musculature. The creation of a video with recorded phonation allowed correlation between palatal movements and specific phonatory tasks.

Modified superior pharyngeal flap for the treatment of velopharyngeal insufficiency in children

ObjectiveTo describe a modified rolled superior pharyngeal flap for treatment of velopharyngeal insufficiency (VPI) in children. MethodsProspective case series at a tertiary care multidisciplinary aerodigestive center. Four children, aged 5–12 years, with VPI refractory to speech therapy resulting after cleft palate (bilateral, submucous, or soft palate only) repair, failed traditional superior pharyngeal flap, fine motor incoordination, or adenoidectomy were studied. All 4 children underwent surgery with a modified superior pharyngeal flap, where aspects of the most commonly employed pharyngeal flap designs were combined to achieve the benefits of each technique and to allow for mucosal covering on either side of the flap, improved control of the lateral port size due to the horizontal-to-horizontal inset technique, and the ability to avoid a vertical or horizontal split in a previously repaired cleft palate. ResultsAll 4 patients demonstrated resolution of their VPI as measured by subjective and/or objective criteria. Every patient required additional speech therapy postoperatively. ConclusionsOur modified superior pharyngeal flap technique may be a good option in patients with small velopharyngeal gaps undergoing revision velopharyngeal surgery. A larger, longitudinal study would better address the overall outcomes of this technique.

Acute isolated velopharyngeal insufficiency in children: case report and systematic review of the literature

Acute isolated velopharyngeal insufficiency (VPI) is a clinical entity mainly reported in children. We undertook a systematic review in order to better characterize its features. Following a Medline search (1960-2012), the authors reviewed and analyzed the cases of acute VPI in children; 36 cases were found. The most common presenting features were hypernasal speech (97 %), nasal reflux (73 %), and dysphagia (49 %). 73 % of the children were males and 27 % females, of 8.9 ± 2.5 years. In all the cases the VPI was unilateral. One quarter of the children had a recent episode of febrile illness and 11 % of the children had an identified infection at the time of presentation (HAV, parvovirus B19, measles, and Coxsackie virus). No associated cause was found in the other cases. All cases resolved completely (67 %) or partially (33 %) without any treatment (89 %) or with prednisolone (11 %). Acute VPI represents a separate entity within the spectrum of VPI and it is a benign self-limiting disorder. The cause remains undetermined but an infectious disorder may play a role at least in some cases. Follow-up is mandatory in order to eliminate progressive conditions such as brainstem neoplasms or inflammatory diseases.

Velopharyngeal Insufficiency and Cleft

Management of orofacial clefts requires a comprehensive approach to address the multifaceted aspects of possible aesthetic and functional deficits. Many children with cleft palate with or without cleft lip continue to have speech abnormalities that can affect socialization, education, and childhood development. An interdisciplinary cleft team ideally manages most orofacial clefts and can include members from the fields of facial plastic surgery, otolaryngology, speech and language pathology, pediatrics, nursing, audiology, genetics, oral surgery, orthodontics, dentistry, and social work. These teams follow a relatively established timeline and algorithm for each of the discrete steps of orofacial cleft treatment. Cleft lip repair is often performed after 3–5 months of age. Palatoplasty is delayed after 8–14 months of age. Speech and language pathology assessment and therapy are targeted as the vocabulary develops (2–5 years old). This special issue deals with the cleft surgeon and speech therapists role in treatment of velopharyngeal dysfunction (VPD), which is often related to velopharyngeal insufficiency (VPI). This lack of coordinated closure of the soft palate to the posterior pharyngeal wall is often a sequela of cleft palate, even after primary repair. One paper from this issue titled “Nonlinear dynamic analysis of vowels in cleft palate children with or without hypernasality” reports on cephalometric differences between the skull base and velopharyngeal anatomy in patients with unilateral cleft lip and palate compared to normal controls. These data contribute to the existing literature of abnormal skull base anatomy and inclination in children with velocardiofacial syndrome, which often associated with VPD. The next paper titled “Noncleft velopharyngeal insufficiency: etiology and need for surgical treatment” analyzes those children with VPD without obvious orofacial clefting, and assesses the etiologies and potential treatment options. This allows for comparison to the traditional orofacial cleft-related VPD management. The velopharyngeal workup is often a coordinated assessment by the cleft surgeon and speech pathologists. It can include subjective assessment, which is the subject of the next two papers. First, the next paper titled “Nonlinear dynamic analysis of vowels in cleft palate children with or without hypernasality” assesses the relationship between two speech assessment tools, Lyapunov exponents, and Nasalance scores in the presence of hypernasal speech. Furthermore, an additional paper titled “Assessment of single-word production for children under three years of age: comparison of children with and without cleft plate” presents a case-control testing of a single word assessment tool in children less than 3 years of age with cleft palate, which indentified speech differences in error patterns, consonants, articulation, and accuracy between children with and with clefts. Objective assessment of VPD also can include either fluoroscopic speech examination or nasopharyngoscopy to characterize the pattern of VPD and target a surgical goal. The next paper titled “Objective assessment of hypernasality in patients with cleft lip and palate with the nasalView system: a clinical validation study” assesses the validity and reliability of a new tool for hypernasality testing called NasalView. Speech and language therapy is instituted to address typical compensatory speech patterns seen in children with cleft palate (e.g., glottal stops). If hypernasal speech is not responsive to speech and language therapy, secondary speech surgery is warranted to address hypernasality in this time period. Surgical options may include a superiorly based pharyngeal flap, dynamic sphincter pharyngoplasty, or posterior pharyngeal wall augmentation. Occasionally, a palate-lengthening procedure (Furlow double-opposing Z-plasty) is performed. These procedures can limit nasal air emissions, but potential obstructive sleep apnea from excessive nasal obstruction is a risk. The risk of sleep apnea after surgically treating the velopharynx may be decreased if the tonsils and adenoids are addressed preemptively. Before pharyngeal flap surgery, some surgeons perform tonsillectomy to limit the potential variability of speech and airway changes that comes with fluctuating tonsillar hypertrophy, tonsillitis, or upper respiratory infections. The use of tonsillectomy in the face of VPI in children with cleft palate is somewhat controversial and is the topic of the last paper “Speech outcomes after tonsillectomy in patients with known velopharyngeal insufficiency”. The guest editors are pleased to present a collection of papers dealing with management of the speech-related difficulties in children with orofacial clefts. In this era of the expanding role of evidenced-based medicine, the effectiveness of treatments can only be monitored and improved by assessment with valid and consistent outcome measures, which are reviewed in this issue. Travis T. Tollefson David White James Brookes Steven Goudy

Histology of the Pharyngeal Constrictor Muscle in 22q11.2 Deletion Syndrome and Non-Syndromic Children with Velopharyngeal Insufficiency

Plastic surgeons aim to correct velopharyngeal insufficiency manifest by hypernasal speech with a velopharyngoplasty. The functional outcome has been reported to be worse in patients with 22q11.2 deletion syndrome than in patients without the syndrome. A possible explanation is the hypotonia that is often present as part of the syndrome. To confirm a myogenic component of the etiology of velopharyngeal insufficiency in children with 22q11.2 deletion syndrome, specimens of the pharyngeal constrictor muscle were taken from children with and without the syndrome. Histologic properties were compared between the groups. Specimens from the two groups did not differ regarding the presence of increased perimysial or endomysial space, fiber grouping by size or type, internalized nuclei, the percentage type I fibers, or the diameters of type I and type II fibers. In conclusion, a myogenic component of the etiology of velopharyngeal insufficiency in children with 22q11.2 deletion syndrome could not be confirmed.

Feasibility of dynamic MRI for evaluating velopharyngeal insufficiency in children

To demonstrate the feasibility of dynamic MRI with near-real-time temporal resolution for analysing velopharyngeal closure. Eleven children and young adults (seven girls, four boys, mean age: 8.4 years) with suspected velopharyngeal insufficiency (VPI), and one healthy volunteer underwent MRI (1.5 Tesla) using T2 fast imaging sequences. Imaging was done without any sedation at rest and during various phonations in the axial and sagittal planes. Images were analysed by two radiologists, a plastic surgeon and a speech therapist. The MRI examinations were well tolerated by even the youngest patient. A qualitative analysis found that the sagittal dynamic sequences during phonation were in relation to the clinical data in all patients. A quantitative analysis enabled calculation of the elevation angle of the soft palate in relation to the hard palate, the velar eminence angle and the percentage of reduction of the antero-posterior diameter of the pharyngeal lumen. Dynamic MRI is a non-invasive, rapid and repeatable method. It can be considered a complementary tool to endoscopy and fluoroscopy, particularly in children, for assessing VPI without any sedation or radiation exposure.

Surgical Correction of Velopharyngeal Insufficiency in Children with Velocardiofacial Syndrome

The surgical management of velopharyngeal insufficiency in children with velocardiofacial syndrome is inherently more difficult, with the need for revision being high. The purpose of this report was to evaluate and document the authors' experience with sphincter pharyngoplasty in the management of velopharyngeal insufficiency in children with velocardiofacial syndrome, and compare outcome. In part I, 32 patients with velocardiofacial syndrome underwent sphincter pharyngoplasty for velopharyngeal insufficiency between January of 1987 and March of 2001. There were 18 girls and 14 boys, with a mean age at primary sphincter pharyngoplasty of 6.7 years. Pharyngoplasty revision was defined as any secondary surgical revision of the sphincter as determined by clinical evaluation and objective speech assessment. In part II, comparisons were made to 218 non-velocardiofacial syndrome patients with velopharyngeal insufficiency who underwent sphincter pharyngoplasty (cleft palate, n = 127; velopharyngeal insufficiency alone, n = 63; submucous cleft, n = 15; other, n = 13). There was no significant difference in the average age or gender in the two groups. All patients underwent screening of velopharyngeal function, which included perceptual speech evaluation, clinical screening of velopharyngeal closure, and oral examination. In part I, success of the primary sphincter pharyngoplasty was demonstrated in 78 percent of the velocardiofacial syndrome patients (n = 25), with a revision rate of 22 percent. Patients who required revision were slightly older, 8.6 versus 6.3 years (p = not significant). Preoperative nasometry scores were significantly higher in patients who required a pharyngoplasty revision (69 versus 54; p = 0.002). Patients who required revision of the pharyngoplasty were more likely to have larger velopharyngeal areas (30 mm versus 22 mm). In part II, the revision rate in patients with velocardiofacial syndrome was significantly higher than in those patients in the original cohort without velocardiofacial syndrome (22 percent versus 11 percent; p < 0.05). Preoperative objective speech data demonstrated significantly greater velopharyngeal incompetence in all categories (nasometry scores, pressure flow measurements, and radiographic measurements) for patients with velocardiofacial syndrome, and age at initial sphincter repair was slightly older (8.5 versus 7.7 years; p = not significant). The management of velopharyngeal insufficiency using sphincter pharyngoplasty in children with velocardiofacial syndrome is safe and effective. The higher need for surgical revision in velocardiofacial syndrome patients is most likely attributable to a greater degree of preoperative nasalance and a slightly later age of presentation. This should provide insight into various technique modifications in an attempt to minimize pharyngoplasty revision.

Longitudinal Follow-Up of Obstructive Sleep Apnea Following Furlow Palatoplasty in Children With Cleft Palate: A Preliminary Report

Abstract Objective: To longitudinally investigate the incidence and severity of obstructive sleep apnea (OSA) following Furlow palatoplasty for velopharyngeal insufficiency (VPI) in children with cleft palate. Subjects: Ten children, six boys and four girls, mean age 5.1 years, at Furlow palatoplasty. Design: Prospective analysis. Main Outcome Measures: Overnight polysomnographic studies were used to determine the incidence and severity of sleep apneas 1 day prior to Furlow palatoplasty, 1 week postoperatively, and approximately 3 and 6 months postoperatively. Results: None of the patients suffered OSA prior to Furlow palatoplasty. A high incidence of mild OSA (100%) occurred during the early postoperative period (p < .001) but resolved within 3 months in all but two patients (20%). Only one OSA (10%) persisted 6 months postoperatively. Conclusions: Furlow palatoplasty for VPI in children with cleft palate might induce temporary and mild OSA.

Current management of velopharyngeal insufficiency in children

Current management of velopharyngeal insufficiency in children

An unusual etiology of velopharyngeal insufficiency

Velopharyngeal insufficiency is usually associated with cleft palate. However, there are also other causes for signs of velopharyngeal insufficiency in speech. We describe an unusual etiology of hypernasality and nasal air emissions in a 5-year-old boy. Based on clinical, logopedic, neuropsychological, nasometric and videofluoroscopic examinations we concluded that velopharyngeal insufficiency in the present patient was associated with clutter-stuttering. We emphasize the need for thorough examinations of the etiology of velopharyngeal insufficiency in children without cleft palate for designing adequate treatment.