Surgical Management of Velopharyngeal Dysfunction in Patients with Cleft Palate: A Systematic Review

Abstract

One of the often-stated goals of cleft care is to establish normal speech. Despite best attempts, primary palatal management does not achieve normal speech in all individuals with cleft palate. That is, 5%- 45% of children born with cleft palate will require secondary surgeries to manage VPD. Perceptual and instrumental speech assessment of VP function are available for differential diagnosis of the VPD and consequently formulating a treatment plan tailored for each case. Available treatment options for VPI include speech therapy, prosthetic devices, and surgical management. Surgical treatment includes, palatal techniques and pharyngeal techniques. Palatal techniques include; re: IVV, DOZ and palatal lengthening by BMMF. Pharyngeal techniques include; PF, SPP and PWA. A combination of these techniques is also reported in literature; either as a single or multiple stages. Since, a wide array of surgical techniques is available for treatment of VPI in patients with CP, a treatment algorithm to guide the surgical treatment is much needed. Therefore, the aim of this study was to review current literature regarding the speech outcome of different techniques of surgical treatment of VPD in cleft patients, in an attempt to reach a treatment algorithm. A systematic review was done, by searching Pubmed, Scopus and Web of Science electronic databases, following the PRISMA guidelines, for articles reporting secondary VPI surgeries on non- syndromic patients with CP. Application of the pre-set selection criteria throughout the screening process, yielded 25 articles, with a total of 5 algorithms, reported in these articles. Articles were categorized the surgical technique used. Raw data was extracted to compare speech outcome and complication of each technique, with special emphasis on the factors affecting, the patients’ selection for each technique.