Treatment Of Cleft-palate Associated With Robin-sequence - Appraisal Of Risk-factors
airway-obstruction; anomalad; cleft palate; Dentistry; management; Oral Surgery & Medicine; robin sequence; sleep-apnea; speech; Surgery
Mandibular hypoplasia, airway obstruction, and a typical wide U-shaped cleft palate comprise the Robin sequence, Although much has been written regarding the treatment of these patients in the neonatal period, the literature reveals little information regarding later care of the cleft palate in these patients, The purpose of this study is to examine patients with the Robin sequence and evaluate the risk of postsurgical problems and outcome related to the neonatal period. Thirty-six patients with the Robin sequence presenting from 1972 through 1990 were reviewed, A majority of patients had feeding and respiratory difficulties, to varying degrees, following birth, These problems were treated successfully by maneuvers ranging from positioning to two infants who eventually required tracheostomy Thirty-four patients had palate repair, Age at repair averaged 16.2 months, and one third of patients had associated anomalies, Infants who experienced problems following palatoplasty were those who had histories of severe difficulties and complications in the early months of life, In addition, patients with associated congenital anomalies had significantly more problems at the time of palate repair than those without anomalies, Those patients with the Robin sequence, who historically had minimal difficulty following birth, experienced few complications at the time of palate repair, Of the 34 patients with repaired palates, 23 demonstrated sufficient follow-up to allow for evaluation of speech outcome, Satisfactory or normal speech production was noted in 65.4%, This is not significantly different from that observed in all patients undergoing cleft palate repair during this same time period (74.9%), Secondary pharyngoplasty procedures were required in 17.4%, An overall complication rate of 29.4% was noted with palatal fistula occurring in 11.8%, Examination of an infant's immediate postnatal period, as well as for the presence of associated anomalies, will provide important predictive information on the potential difficulties following cleft palate repair, In addition, palatoplasty, as part of the overall team approach to the cleft patient, results in a satisfactory speech outcome in approximately two thirds of patients with the Robin sequence.
Lehman J A; Fishman J R A; Neiman G S
Cleft Palate-Craniofacial Journal
1995
1995-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1597/1545-1569(1995)032%3C0025:tocpaw%3E2.3.co;2" target="_blank" rel="noreferrer noopener">10.1597/1545-1569(1995)032%3C0025:tocpaw%3E2.3.co;2</a>
Outcomes in pharyngoplasty: a 10-year experience.
Adult; Female; Male; Ohio; Child; Infant; Risk Factors; Prospective Studies; Age Factors; Sex Factors; Hospitals; Sample Size; Reoperation; Speech; Confidence Intervals; Human; Descriptive Statistics; Middle Age; Adolescence; Retrospective Design; T-Tests; Surgical Flaps; Preschool; Treatment Outcomes; Record Review; Cleft Lip; Cleft Palate; Pediatric – Ohio; Mouth Abnormalities – Surgery; Pharyngeal Diseases – Surgery; Pharynx – Surgery
Objective: The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation.Design: This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes.Participants: Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency.Results: Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p \textgreater .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low.Conclusions: Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.
Pryor LS; Lehman J; Parker M G; Schmidt A; Fox L; Murthy AS
Cleft Palate-Craniofacial Journal
2006
2006-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1597/04-115" target="_blank" rel="noreferrer noopener">10.1597/04-115</a>
Outcomes in pharyngoplasty: a 10-year experience.
Adult; Female; Humans; Male; Middle Aged; Adolescent; Retrospective Studies; Child; Infant; Treatment Outcome; Risk Factors; Age Factors; Sex Factors; Cleft Lip/*surgery; Cleft Palate/*surgery; Pharynx/*surgery; Retreatment/statistics & numerical data; Speech; Velopharyngeal Insufficiency/*surgery; Preschool
OBJECTIVE: The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation. DESIGN: This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes. PARTICIPANTS: Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency. RESULTS: Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p \textgreater .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low. CONCLUSIONS: Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.
Pryor Landon S; Lehman James; Parker Michael G; Schmidt Anna; Fox Lynn; Murthy Ananth S
The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association
2006
2006-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1597/04-115.1" target="_blank" rel="noreferrer noopener">10.1597/04-115.1</a>