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Systematic Review of Postoperative Velopharyngeal Insufficiency: Incidence and Association With Palatoplasty Timing and Technique

Cleft palate is among the most common congenital disorders worldwide and is correctable through surgical intervention. Sub-optimal surgical results may cause velopharyngeal insufficiency (VPI). When symptomatic, VPI can cause hypernasal or unintelligible speech. The postoperative risk of VPI varies...

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Autores principales: Xepoleas, Meredith D., Naidu, Priyanka, Nagengast, Eric, Collier, Zach, Islip, Delaney, Khatra, Jagteshwar, Auslander, Allyn, Yao, Caroline A., Chong, David, Magee, William P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445635/
https://www.ncbi.nlm.nih.gov/pubmed/37646567
http://dx.doi.org/10.1097/SCS.0000000000009555
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author Xepoleas, Meredith D.
Naidu, Priyanka
Nagengast, Eric
Collier, Zach
Islip, Delaney
Khatra, Jagteshwar
Auslander, Allyn
Yao, Caroline A.
Chong, David
Magee, William P.
author_facet Xepoleas, Meredith D.
Naidu, Priyanka
Nagengast, Eric
Collier, Zach
Islip, Delaney
Khatra, Jagteshwar
Auslander, Allyn
Yao, Caroline A.
Chong, David
Magee, William P.
author_sort Xepoleas, Meredith D.
collection PubMed
description Cleft palate is among the most common congenital disorders worldwide and is correctable through surgical intervention. Sub-optimal surgical results may cause velopharyngeal insufficiency (VPI). When symptomatic, VPI can cause hypernasal or unintelligible speech. The postoperative risk of VPI varies significantly in the literature but may be attributed to differences in study size, cleft type, surgical technique, and operative age. To identify the potential impact of these factors, a systematic review was conducted to examine the risk of VPI after primary palatoplasty, accounting for operative age and surgical technique. A search of PubMed, Embase, and Web of Science was completed for original studies that examined speech outcomes after primary palatoplasty. The search identified 4740 original articles and included 35 studies that reported mean age at palatoplasty and VPI-related outcomes. The studies included 10,795 patients with a weighted mean operative age of 15.7 months (range: 3.1–182.9 mo), and 20% (n=2186) had signs of postoperative VPI. Because of the heterogeneity in reporting of surgical technique across studies, small sample sizes, and a lack of statistical power, an analysis of the VPI risk per procedure type and timing was not possible. A lack of data and variable consensus limits our understanding of optimal timing and techniques to reduce VPI occurrence. This paper presents a call-to-action to generate: (1) high-quality research from thoughtfully designed studies; (2) greater global representation; and (3) global consensus informed by high-quality data, to make recommendations on optimal technique and timing for primary palatoplasty to reduce VPI.
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spelling pubmed-104456352023-08-29 Systematic Review of Postoperative Velopharyngeal Insufficiency: Incidence and Association With Palatoplasty Timing and Technique Xepoleas, Meredith D. Naidu, Priyanka Nagengast, Eric Collier, Zach Islip, Delaney Khatra, Jagteshwar Auslander, Allyn Yao, Caroline A. Chong, David Magee, William P. J Craniofac Surg Original Articles Cleft palate is among the most common congenital disorders worldwide and is correctable through surgical intervention. Sub-optimal surgical results may cause velopharyngeal insufficiency (VPI). When symptomatic, VPI can cause hypernasal or unintelligible speech. The postoperative risk of VPI varies significantly in the literature but may be attributed to differences in study size, cleft type, surgical technique, and operative age. To identify the potential impact of these factors, a systematic review was conducted to examine the risk of VPI after primary palatoplasty, accounting for operative age and surgical technique. A search of PubMed, Embase, and Web of Science was completed for original studies that examined speech outcomes after primary palatoplasty. The search identified 4740 original articles and included 35 studies that reported mean age at palatoplasty and VPI-related outcomes. The studies included 10,795 patients with a weighted mean operative age of 15.7 months (range: 3.1–182.9 mo), and 20% (n=2186) had signs of postoperative VPI. Because of the heterogeneity in reporting of surgical technique across studies, small sample sizes, and a lack of statistical power, an analysis of the VPI risk per procedure type and timing was not possible. A lack of data and variable consensus limits our understanding of optimal timing and techniques to reduce VPI occurrence. This paper presents a call-to-action to generate: (1) high-quality research from thoughtfully designed studies; (2) greater global representation; and (3) global consensus informed by high-quality data, to make recommendations on optimal technique and timing for primary palatoplasty to reduce VPI. Lippincott Williams & Wilkins 2023-09 2023-08-30 /pmc/articles/PMC10445635/ /pubmed/37646567 http://dx.doi.org/10.1097/SCS.0000000000009555 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Mutaz B. Habal, MD. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Original Articles
Xepoleas, Meredith D.
Naidu, Priyanka
Nagengast, Eric
Collier, Zach
Islip, Delaney
Khatra, Jagteshwar
Auslander, Allyn
Yao, Caroline A.
Chong, David
Magee, William P.
Systematic Review of Postoperative Velopharyngeal Insufficiency: Incidence and Association With Palatoplasty Timing and Technique
title Systematic Review of Postoperative Velopharyngeal Insufficiency: Incidence and Association With Palatoplasty Timing and Technique
title_full Systematic Review of Postoperative Velopharyngeal Insufficiency: Incidence and Association With Palatoplasty Timing and Technique
title_fullStr Systematic Review of Postoperative Velopharyngeal Insufficiency: Incidence and Association With Palatoplasty Timing and Technique
title_full_unstemmed Systematic Review of Postoperative Velopharyngeal Insufficiency: Incidence and Association With Palatoplasty Timing and Technique
title_short Systematic Review of Postoperative Velopharyngeal Insufficiency: Incidence and Association With Palatoplasty Timing and Technique
title_sort systematic review of postoperative velopharyngeal insufficiency: incidence and association with palatoplasty timing and technique
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445635/
https://www.ncbi.nlm.nih.gov/pubmed/37646567
http://dx.doi.org/10.1097/SCS.0000000000009555
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