Catherine de Blacam1, Susan Smith2, David Orr3. 1. 1 Department of Plastic and Reconstructive Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland. 2. 2 Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland. 3. 3 Departments of Surgery and Paediatrics, Trinity College Dublin, Dublin, Ireland.
Abstract
OBJECTIVE: This systematic review sought to evaluate the consensus in the literature regarding the surgical management of VPD and to determine whether a particular procedure results in superior speech outcome or less morbidity Design: A systematic review was carried out according to PRISMA-P guidelines. Systematic review software was used to facilitate 3-stage screening and data extraction by 2 reviewers. SETTING: University teaching hospital. PATIENTS, PARTICIPANTS: Studies that reported perceptual speech assessment or obstructive sleep apnea (OSA) in patients who had undergone surgery for VPD were included in the review. INTERVENTIONS: Four categories of surgery for VPD were examined-pharyngeal flap, sphincter pharyngoplasty, palatoplasty, and posterior pharyngeal wall augmentation. MAIN OUTCOME MEASURES: Perceptual speech assessment, need for further surgery, and occurrence of OSA were the outcomes of interest. RESULTS: Eighty-three relevant studies were identified, comprising data on 4011 patients. Pharyngeal flap was the most common procedure (64% of patients). Overall, 70.7% of patients attained normal resonance and 65.3% attained normal nasal emission. There was no notable difference in speech outcomes, need for further surgery, or occurrence of OSA across the 4 categories of surgery examined. Heterogeneous groups of patients were reported upon and a variety of perceptual speech assessment scales were used. CONCLUSIONS: There is a lack of consensus in the literature to guide procedure selection for patients with VPD. The development of a standardized minimum data set to record postoperative speech, OSA, and patient-reported outcomes is required.
OBJECTIVE: This systematic review sought to evaluate the consensus in the literature regarding the surgical management of VPD and to determine whether a particular procedure results in superior speech outcome or less morbidity Design: A systematic review was carried out according to PRISMA-P guidelines. Systematic review software was used to facilitate 3-stage screening and data extraction by 2 reviewers. SETTING: University teaching hospital. PATIENTS, PARTICIPANTS: Studies that reported perceptual speech assessment or obstructive sleep apnea (OSA) in patients who had undergone surgery for VPD were included in the review. INTERVENTIONS: Four categories of surgery for VPD were examined-pharyngeal flap, sphincter pharyngoplasty, palatoplasty, and posterior pharyngeal wall augmentation. MAIN OUTCOME MEASURES: Perceptual speech assessment, need for further surgery, and occurrence of OSA were the outcomes of interest. RESULTS: Eighty-three relevant studies were identified, comprising data on 4011 patients. Pharyngeal flap was the most common procedure (64% of patients). Overall, 70.7% of patients attained normal resonance and 65.3% attained normal nasal emission. There was no notable difference in speech outcomes, need for further surgery, or occurrence of OSA across the 4 categories of surgery examined. Heterogeneous groups of patients were reported upon and a variety of perceptual speech assessment scales were used. CONCLUSIONS: There is a lack of consensus in the literature to guide procedure selection for patients with VPD. The development of a standardized minimum data set to record postoperative speech, OSA, and patient-reported outcomes is required.
Authors: Nicole M Kurnik; Erica M Weidler; Kari M Lien; Kelly N Cordero; Jessica L Williams; M'hamed Temkit; Stephen P Beals; Davinder J Singh; Thomas J Sitzman Journal: Cleft Palate Craniofac J Date: 2020-02-19
Authors: R Seselgyte; D Bryant; C Demetriou; M Ishida; E Peskett; N Moreno; D Morrogh; D Sell; M Lees; M Farrall; G E Moore; B Sommerlad; E Pauws; P Stanier Journal: J Dent Res Date: 2019-03-27 Impact factor: 6.116
Authors: Catherine de Blacam; Adriane L Baylis; Richard E Kirschner; Susan M Smith; Debbie Sell; Kathleen C Y Sie; Helen E Harris; David J A Orr Journal: BMJ Open Date: 2020-08-13 Impact factor: 2.692