Submucous Cleft Palate: A Systematic Review of Surgical Management Based on Perceptual and Instrumental Analysis

被引:27
作者
Gilleard, Onur [1 ,2 ]
Sell, Debbie [1 ]
Ghanem, Ali M. [1 ]
Tavsanoglu, Yasemin [1 ,2 ]
Birch, Malcolm [3 ]
Sommerlad, Brian [1 ]
机构
[1] Great Ormond St Hosp Sick Children, North Thames Cleft Serv, London WC1N 3JH, England
[2] Queen Victoria Hosp, E Grinstead, W Sussex, England
[3] Barts & London NHS Trust, Dept Clin Phys, London, England
关键词
hypernasality; intravelar veloplasty; submucous cleft palate (SMCP); velar surgery; velocardiofacial syndrome; velopharyngeal incompetence (VPI); CARDIO-FACIAL SYNDROME; FURLOW Z-PLASTY; VELOPHARYNGEAL INSUFFICIENCY; VELOCARDIOFACIAL SYNDROME; MULTIVIEW VIDEOFLUOROSCOPY; SPHINCTER PHARYNGOPLASTY; DELETION SYNDROME; PHARYNGEAL FLAP; SPEECH OUTCOMES; OCCULT;
D O I
10.1597/13-046
中图分类号
R78 [口腔科学];
学科分类号
1003 ;
摘要
Objective: Submucous cleft palate (SMCP) is a congenital condition associated with abnormal development of the soft palate musculature. In a proportion of cases, this results in velopharyngeal insufficiency (VPI), the treatment for which includes pharyngeal flap surgery, pharyngoplasty, and palate reconstruction. The aim of this paper is to determine whether there is superiority of one or more types of surgical procedure over the others in improving speech in patients with VPI secondary to SMCP. Methodology: Nine databases, including MEDLINE and EMBASE, were searched between inception and January 2013 to identify articles published relating to the surgical management of SMCP. Only studies that reported outcome measures for postoperative speech were included in the systematic review. Results: Twenty-six studies analyzing the outcomes of surgery for VPI in patients with SMCP met the inclusion criteria. In these studies, speech outcomes were measured either in a binary fashion (i.e., normal speech or evidence of VPI) or using scales of VPI severity. Of the 26 studies, only two utilized blinded speech assessment, and 12 included both preoperative and postoperative speech assessment. Conclusions: The review found little evidence to support any specific surgical intervention. This is in large part due to the inclusion of mixed etiologies within study populations and the lack of unbiased validated preoperative and postoperative speech assessment. Further methodologically rigorous studies need to be conducted to provide a secure evidence base for the surgical management of SMCP.
引用
收藏
页码:686 / 695
页数:10
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