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Lynn Marty Grames - One of the best experts on this subject based on the ideXlab platform.

  • Evaluation of Two Palate Repair Techniques for the Surgical Management of Velopharyngeal Insufficiency
    Plastic and Reconstructive Surgery, 2014
    Co-Authors: Albert S. Woo, Gary B. Skolnick, Neil S. Sachanandani, Lynn Marty Grames
    Abstract:

    Background:The Furlow Palatoplasty is commonly used for the correction of velopharyngeal insufficiency in cleft patients. An alternative procedure is introduced involving a single Z-plasty with overlapping intravelar veloplasty (Woo Palatoplasty). This study compared the results of both techniques i

  • The effect of surgeon experience on velopharyngeal functional outcome following Palatoplasty: is there a learning curve?
    Plastic and reconstructive surgery, 1998
    Co-Authors: Peter D. Witt, Lynn Marty Grames, John C. Wahlen, Jeffrey L. Marsh, Thomas K. Pilgram
    Abstract:

    There is little information in the cleft palate literature concerning the relationship between surgeon volume and clinical outcomes. It is unknown whether such a relationship applies specifically to velopharyngeal dysfunction and the need for secondary physical management of the velopharynx. The purpose of this paper was to explore the concept of an operative learning curve for different surgeons with respect to Palatoplasty. Impact of case volume and procedure type on the occurrence of secondary palatal management (the main outcome measure) was assessed. The charts of 472 consecutive Palatoplasty patients were reviewed by one speech and language pathologist to determine when the Palatoplasty was performed, which surgeon (n = 9) performed the Palatoplasty, whether velopharyngeal status was documented at a minimum of 6 years of age, and whether secondary palatal management was prescribed. The results were analyzed by year of Palatoplasty, by surgeon, and by number of operations per surgeon to determine total and individual surgeon rates of secondary palatal management. There were 401 palatoplasties (85 percent recovery) with adequate documentation of velopharyngeal status by at least 6 years of age. Palatoplasty rates ranged between 1 and 258 palatoplasties per surgeon. Over the 12 years reviewed, secondary palatal management was performed for 92 patients (23 percent) of the study population. Examination of the proportion of Palatoplasty patients receiving secondary palatal management by surgeon and by year showed only one surgeon with a pattern suggesting a learning curve. The proportion of patients receiving secondary palatal management was plotted against the total number of surgeries the surgeon performed. There was a strong relationship between experience and success. The number of procedures this surgeon performed per year increased at approximately the same time as the success rate improved. The categories of "total procedures" and "procedure per year" were highly correlated with each other. Success rates were analyzed by number of procedures performed per year, and there was a clear association between the two variables. To separate the effect of the two variables, a multiple regression model was constructed. The category of "total procedures" was statistically significant in the model, whereas procedures per year was not, suggesting that the key to the dominant surgeon's improvement was cumulative experience rather than frequency of performance of the operation. Palatoplasties performed by high-volume surgeons are more likely to result in better postoperative outcomes (i.e., lower rates of secondary palatal management) as compared with palatoplasties performed by low-volume surgeons. The influence of the surgeon's cumulative experience on improvement seems to be more important than the frequency of performance of primary Palatoplasty.

Anne Marie Kuijpersjagtman - One of the best experts on this subject based on the ideXlab platform.

  • maxillofacial growth and speech outcome after one stage or two stage Palatoplasty in unilateral cleft lip and palate a systematic review
    Journal of Cranio-maxillofacial Surgery, 2017
    Co-Authors: Rajgopal R Reddy, Srinivas Gosla Reddy, Anitha Vaidhyanathan, S J Berge, Anne Marie Kuijpersjagtman
    Abstract:

    Abstract Background The number of surgical procedures to repair a cleft palate may play a role in the outcome for maxillofacial growth and speech. The aim of this systematic review was to investigate the relationship between the number of surgical procedures performed to repair the cleft palate and maxillofacial growth, speech and fistula formation in non-syndromic patients with unilateral cleft lip and palate. Material and methods An electronic search was performed in PubMed/old MEDLINE, the Cochrane Library, EMBASE, Scopus and CINAHL databases for publications between 1960 and December 2015. Publications before 1950—journals of plastic and maxillofacial surgery—were hand searched. Additional hand searches were performed on studies mentioned in the reference lists of relevant articles. Search terms included unilateral , cleft lip and/or palate and Palatoplasty . Two reviewers assessed eligibility for inclusion, extracted data, applied quality indicators and graded level of evidence. Results Twenty-six studies met the inclusion criteria. All were retrospective and non-randomized comparisons of one- and two-stage Palatoplasty. The methodological quality of most of the studies was graded moderate to low. The outcomes concerned the comparison of one- and two-stage Palatoplasty with respect to growth of the mandible, maxilla and cranial base, and speech and fistula formation. Conclusions Due to the lack of high-quality studies there is no conclusive evidence of a relationship between one- or two-stage Palatoplasty and facial growth, speech and fistula formation in patients with unilateral cleft lip and palate.

Don Larossa - One of the best experts on this subject based on the ideXlab platform.

Arun K. Gosain - One of the best experts on this subject based on the ideXlab platform.

  • Prophylactic Use of Buccal Fat Flaps to Improve Oral Mucosal Healing following Furlow Palatoplasty.
    Plastic and reconstructive surgery, 2019
    Co-Authors: Cecil S. Qiu, Megan Fracol, Hanah Bae, Arun K. Gosain
    Abstract:

    Furlow Palatoplasty is increasingly used both for primary Palatoplasty and for secondary correction of velopharyngeal insufficiency. Although Furlow Palatoplasty offers the advantage of lengthening the palate, the most tenuous component of the oral mucosal repair is anterior transposition of the oral mucosal Z-plasty flap, with superficial separation of the oral mucosa observed in up to 53 percent of cases of secondary Furlow Palatoplasty. To mitigate this problem, the authors prophylactically placed pedicled buccal fat pad flaps to provide an additional vascular layer to promote healing of the overlying oral mucosal Z-plasty flap. The authors report their experience comprising seven patients who underwent Furlow Palatoplasty with buccal fat flap augmentation. Four of these patients had secondary Furlow Palatoplasty procedures; one of them experienced oral mucosal separation that healed uneventfully. No patients developed an oronasal fistula. The authors' experience suggests that buccal fat flaps may minimize vascular compromise and dehiscence of the oral mucosal Z-plasty following Furlow Palatoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

  • Double-Opposing Z-Palatoplasty for Secondary Surgical Management of Velopharyngeal Incompetence in the Absence of a Primary Furlow Palatoplasty.
    The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 2014
    Co-Authors: Harvey Chim, Yashar Eshraghi, Seree Iamphongsai, Arun K. Gosain
    Abstract:

    Objective: The present study was performed to identify factors that lead to a favorable outcome of postPalatoplasty velopharyngeal incompetence using the double-opposing Z-Palatoplasty. Design: A retrospective analysis was performed on 23 consecutive nonsyndromic patients who underwent secondary surgical management of velopharyngeal incompetence using a double-opposing Z-Palatoplasty technique following primary, non-Furlow Palatoplasty for overt cleft palate. Main Outcome Measures: All subjects were evaluated preoperatively using a perceptual speech assessment scale, nasendoscopy, and videofluoroscopy. Inclusion criteria consisted of a velopharyngeal gap of 9 mm or less on phonation. Patients were followed with perceptual speech assessment for at least 1 year following secondary surgery. Results: The perceptual speech assessment score for all patients decreased from 6.48 ± 2.26 (mean ± standard deviation; range, 3 to 11) to 1.90 ± 1.51 (range, 0 to 6) at 6 months or more postoperatively (P < .0001). Of th...

Albert S. Woo - One of the best experts on this subject based on the ideXlab platform.