title: Superiorly based pharyngeal flap for treatment of velopharyngeal insufficiency in patients with 22q11.2 deletion syndrome.
abstract: BACKGROUND
  There are no previous blinded studies for comparison of preoperative versus postoperative perceptual speech assessments when using a pharyngeal flap for treating velopharyngeal insufficiency (VPI) in patients diagnosed with 22q11.2 deletion syndrome. The aim of the study was to evaluate the effect of superiorly based pharyngeal flap surgery on speech in these patients using blinded judgments of experienced speech therapists.
  
  
  METHODS
  A retrospective study of 12 consecutive patients who had undergone pharyngeal flap surgery for treatment of VPI between 2002 and 2009 was conducted. Seven girls and 5 boys between 4 and 15 (median, 6) years old at the time of surgery were included in the study. Six patients were born with a submucous cleft palate (including 2 occult), and 1 patient, with an overt cleft palate. The remaining 5 patients had no signs of a palatal pathology. All palatal clefts had been repaired before pharyngeal flap surgery except in 2 patients with occult submucous cleft palate. Preoperative and postoperative audio recordings were blinded for scoring independently by 3 senior speech therapists.
  
  
  RESULTS
  There was a significant improvement in hypernasality (P = 0.002), audible nasal emission (P = 0.033), weak pressure consonants (P = 0.008), and speech intelligibility (P = 0.021) after pharyngeal flap surgery. Hyponasality did not develop significantly with surgery. One patient was diagnosed with obstructive sleep apnea.
  
  
  CONCLUSIONS
  Superiorly based pharyngeal flap resulted in a significant speech improvement in 12 consecutive patients with 22q11.2 deletion syndrome having VPI.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. cfilip@ous-hf.no
authors.forename: Charles
authors.initials: C
authors.lastname: Filip
authors.forename: Michael
authors.initials: M
authors.lastname: Matzen
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Aukner
authors.forename: Marianne
authors.initials: M
authors.lastname: Moe
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Høgevold
authors.forename: Frank
authors.initials: F
authors.lastname: Åbyholm
authors.forename: Tore Gunnar
authors.initials: TG
authors.lastname: Abrahamsen
authors.forename: Kim
authors.initials: K
authors.lastname: Tønseth
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications / Q000601:surgery; D004062:DiGeorge Syndrome / Q000150:complications* / Q000235:genetics*; D005260:Female; D006801:Humans; D008297:Male; D010614:Pharynx / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000235:genetics* / Q000601:surgery*