title: Investigation of the speech results of posterior pharyngeal wall augmentation with fat grafting for treatment of velopharyngeal insufficiency.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the speech results of posterior pharyngeal wall augmentation (PPWA) with fat grafting both in the early and late postoperative period, and to clarify the impact of the procedure concomitant with speech therapy.
  
  
  METHODS
  This is a prospective case-control study. The study involved 87 cleft palate ± cleft lip patients with velopharyngeal insufficiency (VPI) who has been treated with PPWA. Patients were separated into two groups according to age; the first group consisted of 49 pediatric participants between 6 and 12 years of age and the second group consisted of 38 adolescent participants between 13 and 18 years of age. Preoperative velopharyngeal function and articulation were compared postoperatively at the following time points: the 3rd month, 12th month, 18th month and 24th month. The velopharyngeal function was evaluated with regards to the velopharyngeal closure type and velopharyngeal closure amount, by using the pediatric flexible nasoendoscopy and the nasometer methods. In the nasometer evaluation, nasalance sores were measured by using nonsense syllables and meaningful sentences. The Ankara Articulation Test (AAT) (Ege et al., 2004) was used to detect compensatory articulation products secondary to VPI. Consonant production error types and frequencies were determined according the guidelines stated in the study of Hardin-Jones et al. (2009). These were Pharyngeal Fricatives - Posterior Nasal Fricatives/Stop Production, Glottal Stop Production, Middorsum Palatal Stop Production, Nasal Frictional Production, Posterior Nasal Frictional Production/Phoneme Specific Nasal Emission, use of Nasal Consonants for Oral Consonants, and Replacement of Trills. All the participants received concurrent speech therapy four times, twice in the post-operative period between 1 and 3 months and twice between 3 and 6 months.
  
  
  RESULTS
  PPWA improved the speech performance from the 18th month to 24th month of the postoperative period. AAT assessment of the first group after 24 months comparing the post-PPWA with the preoperative data showed a highly significant decrease with regard to compensatory production errors and hypernasality; however, in the second group, the same comparison revealed a highly significant decrease in regard to the degree of hypernasality and a significant difference in terms of glottal articulation and pharyngealization of fricatives. A circular closure pattern was observed in 17 individuals with cleft palate at a rate of 70.6%.
  
  
  CONCLUSIONS
  PPWA with concurrent speech therapy is an acceptable surgical method to correct VPI and to improve speech performance.
authors.affiliation: Department of Audiology and Speech Pathology, Audiologist and Speech Pathologist, Hacettepe University Health Sciences Institute, Ankara, Turkiye; Numune Education and Research Hospital, ENT Clinic, Center of Hearing, Speech and Balance, Ankara, Turkiye. Electronic address: cagladinsever@gmail.com.
authors.forename: Çağla
authors.initials: Ç
authors.lastname: Dinsever Eliküçük
authors.affiliation: Speech and Language Therapy, Hacettepe University Health Science Faculty, Hacettepe University Faculty of Health Sciences Vice Dean, Bologna Coordinator, Sıhhiye, Ankara, Turkiye. Electronic address: mekkayikci@gmail.com.
authors.forename: Maviş Emel
authors.initials: ME
authors.lastname: Kulak Kayıkcı
authors.affiliation: Speech and Language Therapy, Hacettepe University, Health Science Faculty, Ankara, Turkiye. Electronic address: fesen04@gmail.com.
authors.forename: Fatma
authors.initials: F
authors.lastname: Esen Aydınlı
authors.affiliation: Hacettepe Hospital University, Medicine Faculty Professor in Plastic Reconstructive Surgery, Sıhhiye, Ankara, Turkiye. Electronic address: mertcalis@gmail.com.
authors.forename: Mert
authors.initials: M
authors.lastname: Çalış
authors.affiliation: Department of Plastic, Reconstructive and Esthetic Surgery, Faculty of Medicine, Hacettepe University, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Ankara, Turkiye. Electronic address: figenozgur@gmail.com.
authors.forename: Fatma Figen
authors.initials: FF
authors.lastname: Özgür
authors.affiliation: Hacettepe Hospital University, Ankara, Turkiye. Electronic address: mehtap.1112@gmail.com.
authors.forename: Mehtap
authors.initials: M
authors.lastname: Öztürk
authors.affiliation: Hacettepe Hospital University, Medicine Faculty, Ear, Nose and Throat Department, 06000, Ankara, Turkiye. Electronic address: rogunaydin@gmail.com.
authors.forename: Rıza Önder
authors.initials: RÖ
authors.lastname: Günaydın
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000293:Adolescent; D001184:Articulation Disorders / Q000534:rehabilitation*; D016022:Case-Control Studies; D002648:Child; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010614:Pharynx / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery*
keywords: Cleft palate; Compensatory articulation products; Hypernasality; Posterior pharyngeal wall augmentation; Speech therapy; Velopharyngeal insufficiency