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Speech Outcomes Do Not Revert Following Posterior Pharyngeal Flap Takedown For Obstructive Sleep Apnea
Evan B. Katzel, MD, Sanjay Naran, MD, Matthew D. Ford, MS, CCC-SLP, Joseph E. Losee, MD.
University of Pittsburgh, Pittsburgh, PA, USA.

BACKGROUND:
Velopharyngeal insufficiency (VPI) affects as many as one in three patients following cleft palate repair. Correction using a posterior pharyngeal flap (PPF) has been shown to improve clinical speech symptomatology; however, PPFs can be complicated by obstructive sleep apnea (OSA). The goal of this study was to assess if speech outcomes revert following PPF takedown for the treatment of OSA.
METHODS:
The Cleft-Craniofacial Database of the Children’s Hospital of Pittsburgh of UPMC was retrospectively queried to identify patients with a diagnosis of VPI that were treated with a PPF & ultimately required takedown. Using the Pittsburgh Weighted Speech Score (PWSS), pre-operative scores were compared to those following surgical takedown/revision. Given that surgical correction of OSA differed, the method of surgical correction (PPF takedown, conversion Furlowplasty, conversion pharyngoplasty) was stratified & cross-compared.
RESULTS:
A total of 58 patients were identified. Of these, 22 underwent PPF takedown alone, 34 underwent PPF takedown with conversion to Furlow palatoplasty, & 2 underwent PPF takedown with conversion to pharyngoplasty. Patients averaged 13.87±5.96 (mean±SD) years of age at the time of PPF takedown, and 50% were male. Demographics between groups were not statistically different. The mean duration of follow up after surgery was 40.13±27.88 months. For patients undergoing PPF takedown alone, the mean pre-operative and post-operative PWSS was 2.23±3.44 and 2.55±3.32, respectively (p=0.71). The mean change in PWSS was 0.11±3.38. For patients undergoing conversion to Furlowplasty, the mean pre-operative and post-operative PWSS was 6.35±6.95 and 4.42±5.85, respectively (p=0.22). The mean change in PWSS was -1.88±5.45. For all patients, the mean pre-operative PWSS was 5.02±6.22, compared to 3.94±5.15 following takedown (p=0.33). There was no statistically significant change in PWSS for any of the surgical interventions used to correct OSA.
CONCLUSIONS:
While there is concern that PPF takedown may degrade speech, this study finds that surgical takedown of PPF in the setting of OSA does not result in a statistically significant change in PWSS.


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