Our Summary

In this research, the authors discuss a new surgical technique they have developed to help people who, despite initial surgery to repair a cleft palate, still have problems with speaking and nasal sounding voice. This issue is known as velopharyngeal insufficiency (VPI). The new surgical technique, called strip pharyngoplasty, involves the middle muscle in the throat and enhances the function of a flap in the throat. The authors detail the steps of this surgery, who could benefit from it, its advantages, and possible limitations. This technique seems to be particularly useful for cases where the patient’s throat muscles are not contracting adequately, as it adds an extra layer of muscle support to the throat flap.

FAQs

  1. What is velopharyngeal insufficiency (VPI) and how is it related to cleft palate surgeries?
  2. Can you explain the strip pharyngoplasty technique used for secondary surgery for persistent VPI after primary cleft palate repair?
  3. What are the advantages and limitations of the strip pharyngoplasty technique?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cleft palate surgery is to follow post-operative care instructions carefully, including maintaining good oral hygiene and attending all follow-up appointments. It is also important to follow any speech therapy recommendations to help improve speech and swallowing function after surgery.

Suitable For

Patients with cleft palate who experience velopharyngeal insufficiency (VPI) despite a satisfactory primary repair are typically recommended for strip pharyngoplasty surgery. This procedure is particularly beneficial for cases with defective muscle contraction in the pharynx, resulting in hypernasality and phonation disorders. Strip pharyngoplasty can help improve the function of the pharyngeal flap and address persistent VPI after primary cleft palate repair. This surgical technique is designed to provide a muscle contingent in addition to the mucosal flap, leading to improved speech and swallowing outcomes for patients with cleft palate.

Timeline

Before cleft palate surgery:

  1. Patient is diagnosed with a cleft palate, leading to difficulties with speech, feeding, and other functions.
  2. Patient undergoes pre-operative evaluations and consultations with a multidisciplinary team of healthcare professionals.
  3. Patient and family receive education about the surgery, potential risks and benefits, and post-operative care.

After cleft palate surgery:

  1. Patient undergoes cleft palate repair surgery, which involves closing the gap in the palate and reconstructing the soft tissues.
  2. Patient may experience pain, swelling, and discomfort in the immediate post-operative period.
  3. Patient receives post-operative care, including pain management, wound care, and monitoring for complications.
  4. Patient undergoes speech therapy to improve speech and language development.
  5. In cases where velopharyngeal insufficiency (VPI) persists after primary repair, the patient may undergo a secondary pharyngoplasty, such as strip pharyngoplasty, to improve function of the pharyngeal flap and address hypernasality and phonation disorders.
  6. Patient continues to receive follow-up care and support from the healthcare team to monitor progress and address any ongoing concerns.

What to Ask Your Doctor

  1. What is the success rate of cleft palate surgery in improving speech and swallowing function?
  2. Are there any potential risks or complications associated with cleft palate surgery?
  3. How long is the recovery process after cleft palate surgery?
  4. Will my child need any additional surgeries or treatments after the initial cleft palate repair?
  5. What type of follow-up care will be needed after cleft palate surgery?
  6. How soon after birth should cleft palate surgery be performed?
  7. Are there any specific dietary or lifestyle changes that should be made before or after cleft palate surgery?
  8. What type of anesthesia will be used during the cleft palate surgery?
  9. What can be done to minimize scarring or visible marks after cleft palate surgery?
  10. Are there any alternative treatments or procedures that should be considered in addition to cleft palate surgery?

Reference

Authors: Barry F, Schlund M, Ferri J. Journal: J Stomatol Oral Maxillofac Surg. 2024 Jun;125(3):101684. doi: 10.1016/j.jormas.2023.101684. Epub 2023 Nov 10. PMID: 37951499