title: Sphincterplasty for Velopharyngeal Insufficiency in the Child Without a Cleft-Palate: Etiologies and Speech Outcomes.
abstract: The aim of this study is to report on speech outcomes following surgery for velopharyngeal insufficiency (VPI) on a broad spectrum of patients without a cleft palate. Inclusion criteria included patients without a cleft palate operated on by a single surgeon (JKW) over a 10-year period and postoperative speech evaluation within 1 year. All patients underwent a sphincter pharyngoplasty. The main outcome measures were perceptual speech assessment using a 6-point scale (1 = none or normal, 6 = severe); velopharyngeal function (VPF) (1 = adequate, 2 = marginal, 3 =  dequate); and quantitative nasalance score. Forty children (mean age 7.5 y) were included. Eight unique conditions were identified; the most common was 22q deletion syndromes (27.5%). All patients had a deep nasopharynx, mean nasopharyngeal depth >0.67. Two novel cases are presented in each child with mosaic Trisomy 14 and ring chromosome 18 abnormality. Of all patients, 87.5% improved their postoperative hypernasality score. Preoperatively, all patients had either marginal or inadequate VPF (2 or 3). Postoperatively, 90% of patients (n = 36) achieved adequate velar function, the remainder did not improve at the first postoperative evaluation. Intelligibility and audible nasal emissions improved in between 57% and 65% of patients. Articulation proficiency was the only perceptual rating not to improve initially, but then did so on the most recent postoperative speech evaluation. This study demonstrates successful speech outcomes in a diverse group of patients. It also increases awareness of noncleft VPI amenable to surgical correction.
authors.affiliation: *Institute of Reconstructive Plastic Surgery, New York University, New York †Center for Craniofacial Disorders, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA ‡Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL §Center for Craniofacial Disorders, Speech Pathology Laboratory, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA ||Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Golinko
authors.forename: Kazlin
authors.initials: K
authors.lastname: Mason
authors.forename: Katie
authors.initials: K
authors.lastname: Nett
authors.forename: John E
authors.initials: JE
authors.lastname: Riski
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Williams
mesh_terms: D058165:22q11 Deletion Syndrome / Q000150:complications; D002508:Cephalometry / Q000379:methods; D002648:Child; D002883:Chromosomes, Human, Pair 14 / Q000235:genetics; D002887:Chromosomes, Human, Pair 18 / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009030:Mosaicism; D009305:Nasopharynx / Q000000981:diagnostic imaging; D010160:Palate, Soft / Q000502:physiology; D010614:Pharynx / Q000502:physiology; D011859:Radiography; D012303:Ring Chromosomes; D013060:Speech / Q000502:physiology*; D013065:Speech Intelligibility / Q000502:physiology; D016896:Treatment Outcome; D014314:Trisomy / Q000235:genetics; D014681:Velopharyngeal Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D055158:Velopharyngeal Sphincter / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery*; D014833:Voice Quality / Q000502:physiology