title: Process and outcome study of multidisciplinary prosthetic treatment for velopharyngeal dysfunction.
abstract: BACKGROUND
  A prosthetic approach to velopharyngeal dysfunction (VPD) is not new. However, a collaborative interdisciplinary team approach by a speech-and-language therapist, dental specialist and maxillofacial technician, including accurate fitting using nasendoscopy, has provided an opportunity to define the clinical care pathway, and audit the outcomes of this intervention. Systematic outcome studies of the effectiveness of prosthetic appliances are few and largely anecdotal.
  
  
  OBJECTIVE
  The aim is twofold: first, to provide a description of the process including diagnosis, clinical and technical fabrication; and second, to determine the effectiveness of this intervention with nasendoscopy, objective blind perceptual analysis of speech data and nasometry.
  
  
  METHODS
  The selection criteria, age, aetiology and process of fabrication are described. Thirty-one patients embarked on the programme, but seven patients after initial failure or refusal were re-entered into the programme for a second time resulting in 38 interventions. At the time of audit, 20 patients had completed the treatment, but four of these were inadequately documented. This study reports on the 16 patients who successfully completed the programme and who had comprehensive records.
  
  
  RESULTS
  Significant differences were found between the pre- and post-treatment evaluations on the speech parameters of hypernasality, audible nasal emission and nasometry.
  
  
  CONCLUSIONS
  In our centre surgery is the first choice of treatment for VPD, but prosthetic management can be a useful alternative when this is contraindicated, can be a useful temporary solution and can be used to evaluate the potential benefits of surgical intervention in some cases. This treatment requires the combined expertise of an interdisciplinary team involving the speech-and-language therapist, orthodontist/prosthodontist, maxillofacial technician and endoscopist.
authors.affiliation: Speech and Language Therapy Department. Great Ormond Street Hospital for Children NHS Trust, London, UK. SELLD@gosh.nhs.uk
authors.forename: Debbie
authors.initials: D
authors.lastname: Sell
authors.forename: Michael
authors.initials: M
authors.lastname: Mars
authors.forename: Emma
authors.initials: E
authors.lastname: Worrell
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy; D017267:Dental Prosthesis Design; D004724:Endoscopy; D005500:Follow-Up Studies; D006801:Humans; D009296:Nasal Cavity / Q000503:physiopathology; D010043:Outcome and Process Assessment, Health Care; D010158:Palatal Obturators; D010348:Patient Care Team; D011859:Radiography; D013064:Speech Disorders / Q000209:etiology / Q000534:rehabilitation; D013068:Speech Production Measurement / Q000379:methods; D013070:Speech Therapy; D014681:Velopharyngeal Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation*