title: A Treatment Protocol for Velopharyngeal Insufficiency and the Outcome.
abstract: BACKGROUND
  A simple algorithm is applied to treat velopharyngeal insufficiency. The purpose of this study was to assess its success rate and complications.
  
  
  METHODS
  The diagnosis includes speech perceptual assessment and nasopharyngoscopy, focusing on velopharyngeal closure ratio. The treatment is composed of a double-opposing Z-plasty for marginal velopharyngeal insufficiency or a pharyngeal flap for moderate to severe velopharyngeal insufficiency. A retrospective chart review was conducted for 84 consecutive nonsyndromic postpalatoplasty patients undergoing velopharyngeal insufficiency surgery from August of 2007 to December of 2014. The demographic, perioperative, and follow-up data were collected. Statistical analyses were performed.
  
  
  RESULTS
  Mean age at velopharyngeal insufficiency surgery was 7.0 years. The overall improvement rate for patients was 86.9 percent. Nine patients in the double-opposing Z-plasty group and two patients in the pharyngeal flap group were refractory to velopharyngeal insufficiency surgery. The improvement rates for each surgical group were 80.4 percent for the double-opposing Z-plasty group and 94.7 percent for the pharyngeal flap group. There were no significant differences in postoperative velopharyngeal function between the coronal and noncoronal groups. Airway-associated complications were observed in nine patients (10.7 percent). The complications in the double-opposing Z-plasty group were observed in two patients (4.3 percent), and none of the patients presented obstructive sleep apnea. Seven patients (18.4 percent) in the pharyngeal flap group showed postoperative snoring, and one (2.6 percent) of them presented with obstructive sleep apnea.
  
  
  CONCLUSIONS
  The authors' algorithm is a simple patient- and surgeon-friendly strategy to obtain satisfactory improvement of velopharyngeal function for velopharyngeal insufficiency patients, with a low risk of airway complications.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Taoyuan, Taiwan.|From the Department of Plastic and Reconstructive Surgery and the Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Yamaguchi
authors.affiliation: Taoyuan, Taiwan.|From the Department of Plastic and Reconstructive Surgery and the Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lonic
authors.affiliation: Taoyuan, Taiwan.|From the Department of Plastic and Reconstructive Surgery and the Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University.
authors.forename: Che-Hsiung
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Taoyuan, Taiwan.|From the Department of Plastic and Reconstructive Surgery and the Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University.
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Wang
authors.affiliation: Taoyuan, Taiwan.|From the Department of Plastic and Reconstructive Surgery and the Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University.
authors.forename: Claudia
authors.initials: C
authors.lastname: Yun
authors.affiliation: Taoyuan, Taiwan.|From the Department of Plastic and Reconstructive Surgery and the Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University.
authors.forename: Lun-Jou
authors.initials: LJ
authors.lastname: Lo
mesh_terms: D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013060:Speech / Q000502:physiology*; D013524:Surgical Flaps; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000503:physiopathology / Q000601:surgery*