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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.
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.
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.
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.
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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