title: Pharyngeal flap versus sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency: a meta-analysis.
abstract: BACKGROUND
  Velopharyngeal insufficiency (VPI) has been reported in 5-20% of patients following cleft palate repair. Since VPI can limit communication, determining which operative procedure leads to the greatest improvement is of utmost importance. Since there is no consensus, this meta-analysis aims to determine which procedure results in the most significant resolution of VPI.
  
  
  METHODS
  Two independent assessors undertook a literature review for articles that compare procedures aimed at treating VPI. Study quality was determined using validated scales. Level of agreement was assessed using intra-class coalition coefficient analysis. The heterogeneity between studies was evaluated using I(2) and Cochran's Q-statistic. Random effect model analysis and forest plots were used to report a pooled odds ratio (OR) and 95% confidence intervals (CI) for treatment effect. A p-value of 0.05 was considered for statistical significance.
  
  
  RESULTS
  Two randomised controlled trials (RCTs) comparing pharyngeal flap to sphincter pharyngoplasty were obtained. A total of 133 patients were included, with follow-ups at 3-4 months. The pooled OR was determined to be 2.95 (95% CI: 0.66-13.23) in favour of the pharyngeal flap.
  
  
  CONCLUSIONS
  Based on these RCTs, which currently compose the highest quality data that compares pharyngeal flap versus pharyngoplasty, the pooled treatment effect suggests a possible trend favouring pharyngeal flap.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Collins
authors.forename: Kevin
authors.initials: K
authors.lastname: Cheung
authors.forename: Forough
authors.initials: F
authors.lastname: Farrokhyar
authors.forename: Nick
authors.initials: N
authors.lastname: Strumas
mesh_terms: D002648:Child; D002972:Cleft Palate / Q000601:surgery; D006801:Humans; D010609:Pharyngeal Muscles / Q000637:transplantation*; D016032:Randomized Controlled Trials as Topic; D013065:Speech Intelligibility; D013524:Surgical Flaps; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000601:surgery*