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Corstiaan C. Breugem - One of the best experts on this subject based on the ideXlab platform.
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Velopharyngeal Insufficiency treated with levator muscle repositioning and unilateral myomucosal buccinator flap
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: Robrecht J H Logjes, Maaike T A Van Den Aardweg, Meike M J Blezer, Anne M B Van Der Heul, Corstiaan C. BreugemAbstract:Abstract Purpose Velopharyngeal Insufficiency (VPI) is common (20–30%) after cleft palate closure. The myomucosal buccinator flap has become an important treatment option for Velopharyngeal Insufficiency; however, published studies all use bilateral buccinator flaps. This study assesses outcomes with a unilateral myomucosal buccinator flap that might result in less operating time and might prevent the need of a bite block and an extra procedure for division of the flap pedicle at a later stage. Materials and methods Forty-two consecutive patients who underwent a unilateral myomucosal buccinator flap procedure were retrospectively reviewed. Overall clinical judgment of speech, speech analysis, and Velopharyngeal closure were evaluated by a multidisciplinary cleft palate team. Results Median follow-up was 1.2 years. In 83% of patients, overall clinical judgment of optimal speech was obtained and thus no further Velopharyngeal surgery was necessary. In 7 patients, further surgery was necessary, of whom 57% (4/7) had bilateral cleft lip−palate. Mean level of intelligibility improved significantly as evaluated by speech pathologists (2.5 ± 0.9 vs 3.5 ± 0.9; P Conclusion The unilateral myomucosal buccinator flap seems to be an effective and safe procedure and should become part of the armamentarium of cleft surgeons.
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Histology of the pharyngeal constrictor muscle in 22q11.2 deletion syndrome and non-syndromic children with Velopharyngeal Insufficiency
PLoS ONE, 2011Co-Authors: J. Widdershoven, Nicole E. Spruijt, Wim G.m. Spliet, Corstiaan C. Breugem, Moshe Kon, Aebele B. Mink Van Der MolenAbstract:Plastic surgeons aim to correct Velopharyngeal Insufficiency manifest by hypernasal speech with a velopharyngoplasty. The functional outcome has been reported to be worse in patients with 22q11.2 deletion syndrome than in patients without the syndrome. A possible explanation is the hypotonia that is often present as part of the syndrome. To confirm a myogenic component of the etiology of Velopharyngeal Insufficiency in children with 22q11.2 deletion syndrome, specimens of the pharyngeal constrictor muscle were taken from children with and without the syndrome. Histologic properties were compared between the groups. Specimens from the two groups did not differ regarding the presence of increased perimysial or endomysial space, fiber grouping by size or type, internalized nuclei, the percentage type I fibers, or the diameters of type I and type II fibers. In conclusion, a myogenic component of the etiology of Velopharyngeal Insufficiency in children with 22q11.2 deletion syndrome could not be confirmed.
John E. Riski - One of the best experts on this subject based on the ideXlab platform.
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surgical correction of Velopharyngeal Insufficiency in children with velocardiofacial syndrome
Plastic and Reconstructive Surgery, 2006Co-Authors: Albert Losken, J. Kerwin Williams, Fernando D. Burstein, Deonne Malick, John E. RiskiAbstract:BACKGROUND: The surgical management of Velopharyngeal Insufficiency in children with velocardiofacial syndrome is inherently more difficult, with the need for revision being high. The purpose of this report was to evaluate and document the authors' experience with sphincter pharyngoplasty in the management of Velopharyngeal Insufficiency in children with velocardiofacial syndrome, and compare outcome. METHODS: In part I, 32 patients with velocardiofacial syndrome underwent sphincter pharyngoplasty for Velopharyngeal Insufficiency between January of 1987 and March of 2001. There were 18 girls and 14 boys, with a mean age at primary sphincter pharyngoplasty of 6.7 years. Pharyngoplasty revision was defined as any secondary surgical revision of the sphincter as determined by clinical evaluation and objective speech assessment. In part II, comparisons were made to 218 non-velocardiofacial syndrome patients with Velopharyngeal Insufficiency who underwent sphincter pharyngoplasty (cleft palate, n = 127; Velopharyngeal Insufficiency alone, n = 63; submucous cleft, n = 15; other, n = 13). There was no significant difference in the average age or gender in the two groups. All patients underwent screening of Velopharyngeal function, which included perceptual speech evaluation, clinical screening of Velopharyngeal closure, and oral examination. RESULTS: In part I, success of the primary sphincter pharyngoplasty was demonstrated in 78 percent of the velocardiofacial syndrome patients (n = 25), with a revision rate of 22 percent. Patients who required revision were slightly older, 8.6 versus 6.3 years (p = not significant). Preoperative nasometry scores were significantly higher in patients who required a pharyngoplasty revision (69 versus 54; p = 0.002). Patients who required revision of the pharyngoplasty were more likely to have larger Velopharyngeal areas (30 mm versus 22 mm). In part II, the revision rate in patients with velocardiofacial syndrome was significantly higher than in those patients in the original cohort without velocardiofacial syndrome (22 percent versus 11 percent; p < 0.05). Preoperative objective speech data demonstrated significantly greater Velopharyngeal incompetence in all categories (nasometry scores, pressure flow measurements, and radiographic measurements) for patients with velocardiofacial syndrome, and age at initial sphincter repair was slightly older (8.5 versus 7.7 years; p = not significant). CONCLUSIONS: The management of Velopharyngeal Insufficiency using sphincter pharyngoplasty in children with velocardiofacial syndrome is safe and effective. The higher need for surgical revision in velocardiofacial syndrome patients is most likely attributable to a greater degree of preoperative nasalance and a slightly later age of presentation. This should provide insight into various technique modifications in an attempt to minimize pharyngoplasty revision.
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Surgical correction of Velopharyngeal Insufficiency in children with velocardiofacial syndrome.
Plastic and Reconstructive Surgery, 2006Co-Authors: Albert Losken, Fernando D. Burstein, Deonne Malick, Joseph K. Williams, John E. RiskiAbstract:Background:The surgical management of Velopharyngeal Insufficiency in children with velocardiofacial syndrome is inherently more difficult, with the need for revision being high. The purpose of this report was to evaluate and document the authors' experience with sphincter pharyngoplasty in the mana
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An outcome evaluation of sphincter pharyngoplasty for the management of Velopharyngeal Insufficiency
2003Co-Authors: Albert Losken, J. Kerwin Williams, Fernando D. Burstein, Deonne Malick, John E. RiskiAbstract:Sphincter pharyngoplasty is frequently used for the management of children with Velopharyngeal Insufficiency. The purpose of this study was to evaluate outcome and revision rates of sphincter pharyngoplasty at the authors' institution. Two hundred fifty patients underwent sphincter pharyngoplasty for Velopharyngeal Insufficiency between January of 1987 and March of 2001. There were 117 female patients and 133 male patients, with a mean age at primary sphincter pharyngoplasty of 7.6 years (range, 1 to 45 years). Diagnoses included Velopharyngeal Insufficiency alone (n = 63), Velopharyngeal Insufficiency associated with cleft palate (n = 127), velocardiofacial syndrome (n = 32), submucous cleft (n = 15), and other (n = 13). Pharyngoplasty revision was defined as any secondary surgical revision of the sphincter as determined by clinical evaluation and objective speech assessment. The pharyngoplasty revision rate was found to be 12.8 percent (n = 32). A favorable outcome was demonstrated in 30 of these patients (93.8 percent) after pharyngoplasty revision. Two patients, one with a diagnosis of a submucous cleft and velocardiofacial syndrome and the other with a cleft palate, required a second revision because of persistent Velopharyngeal Insufficiency. The revision rate was highest in those patients with velocardiofacial syndrome (21.8 percent) and lowest in patients with Velopharyngeal Insufficiency alone (6.3 percent). Patients who required revision had significantly higher preoperative oral sentence nasometry (55.2 percent versus 46.1 percent; p < 0.01) and larger Velopharyngeal areas (23.7 mm 2 versus 18.9 mm 2 ). There was no significant difference in age or sex for those patients who required a revision compared with those who did not require revision. Mean follow-up was 2.4 years (range, 4 months to 13.6 years). Sphincter pharyngoplasty is an effective procedure for the treatment of Velopharyngeal Insufficiency using revision rate as the standard of success. It had an 87 percent primary success rate that increased to 99 percent after a single revision. Patients with velocardiofacial syndrome, more severe preoperative hypernasal resonance, and larger Velopharyngeal areas were mole likely to require pharyngoplasty revision.
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An outcome evaluation of sphincter pharyngoplasty for the management of Velopharyngeal Insufficiency.
Plastic and Reconstructive Surgery, 2003Co-Authors: Albert Losken, J. Kerwin Williams, Fernando D. Burstein, Deonne Malick, John E. RiskiAbstract:Sphincter pharyngoplasty is frequently used for the management of children with Velopharyngeal Insufficiency. The purpose of this study was to evaluate outcome and revision rates of sphincter pharyngoplasty at the authors’ institution. Two hundred fifty patients underwent sphincter pharyngoplasty fo
Robrecht J H Logjes - One of the best experts on this subject based on the ideXlab platform.
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Velopharyngeal Insufficiency treated with levator muscle repositioning and unilateral myomucosal buccinator flap
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: Robrecht J H Logjes, Maaike T A Van Den Aardweg, Meike M J Blezer, Anne M B Van Der Heul, Corstiaan C. BreugemAbstract:Abstract Purpose Velopharyngeal Insufficiency (VPI) is common (20–30%) after cleft palate closure. The myomucosal buccinator flap has become an important treatment option for Velopharyngeal Insufficiency; however, published studies all use bilateral buccinator flaps. This study assesses outcomes with a unilateral myomucosal buccinator flap that might result in less operating time and might prevent the need of a bite block and an extra procedure for division of the flap pedicle at a later stage. Materials and methods Forty-two consecutive patients who underwent a unilateral myomucosal buccinator flap procedure were retrospectively reviewed. Overall clinical judgment of speech, speech analysis, and Velopharyngeal closure were evaluated by a multidisciplinary cleft palate team. Results Median follow-up was 1.2 years. In 83% of patients, overall clinical judgment of optimal speech was obtained and thus no further Velopharyngeal surgery was necessary. In 7 patients, further surgery was necessary, of whom 57% (4/7) had bilateral cleft lip−palate. Mean level of intelligibility improved significantly as evaluated by speech pathologists (2.5 ± 0.9 vs 3.5 ± 0.9; P Conclusion The unilateral myomucosal buccinator flap seems to be an effective and safe procedure and should become part of the armamentarium of cleft surgeons.
Albert Losken - One of the best experts on this subject based on the ideXlab platform.
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surgical correction of Velopharyngeal Insufficiency in children with velocardiofacial syndrome
Plastic and Reconstructive Surgery, 2006Co-Authors: Albert Losken, J. Kerwin Williams, Fernando D. Burstein, Deonne Malick, John E. RiskiAbstract:BACKGROUND: The surgical management of Velopharyngeal Insufficiency in children with velocardiofacial syndrome is inherently more difficult, with the need for revision being high. The purpose of this report was to evaluate and document the authors' experience with sphincter pharyngoplasty in the management of Velopharyngeal Insufficiency in children with velocardiofacial syndrome, and compare outcome. METHODS: In part I, 32 patients with velocardiofacial syndrome underwent sphincter pharyngoplasty for Velopharyngeal Insufficiency between January of 1987 and March of 2001. There were 18 girls and 14 boys, with a mean age at primary sphincter pharyngoplasty of 6.7 years. Pharyngoplasty revision was defined as any secondary surgical revision of the sphincter as determined by clinical evaluation and objective speech assessment. In part II, comparisons were made to 218 non-velocardiofacial syndrome patients with Velopharyngeal Insufficiency who underwent sphincter pharyngoplasty (cleft palate, n = 127; Velopharyngeal Insufficiency alone, n = 63; submucous cleft, n = 15; other, n = 13). There was no significant difference in the average age or gender in the two groups. All patients underwent screening of Velopharyngeal function, which included perceptual speech evaluation, clinical screening of Velopharyngeal closure, and oral examination. RESULTS: In part I, success of the primary sphincter pharyngoplasty was demonstrated in 78 percent of the velocardiofacial syndrome patients (n = 25), with a revision rate of 22 percent. Patients who required revision were slightly older, 8.6 versus 6.3 years (p = not significant). Preoperative nasometry scores were significantly higher in patients who required a pharyngoplasty revision (69 versus 54; p = 0.002). Patients who required revision of the pharyngoplasty were more likely to have larger Velopharyngeal areas (30 mm versus 22 mm). In part II, the revision rate in patients with velocardiofacial syndrome was significantly higher than in those patients in the original cohort without velocardiofacial syndrome (22 percent versus 11 percent; p < 0.05). Preoperative objective speech data demonstrated significantly greater Velopharyngeal incompetence in all categories (nasometry scores, pressure flow measurements, and radiographic measurements) for patients with velocardiofacial syndrome, and age at initial sphincter repair was slightly older (8.5 versus 7.7 years; p = not significant). CONCLUSIONS: The management of Velopharyngeal Insufficiency using sphincter pharyngoplasty in children with velocardiofacial syndrome is safe and effective. The higher need for surgical revision in velocardiofacial syndrome patients is most likely attributable to a greater degree of preoperative nasalance and a slightly later age of presentation. This should provide insight into various technique modifications in an attempt to minimize pharyngoplasty revision.
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Surgical correction of Velopharyngeal Insufficiency in children with velocardiofacial syndrome.
Plastic and Reconstructive Surgery, 2006Co-Authors: Albert Losken, Fernando D. Burstein, Deonne Malick, Joseph K. Williams, John E. RiskiAbstract:Background:The surgical management of Velopharyngeal Insufficiency in children with velocardiofacial syndrome is inherently more difficult, with the need for revision being high. The purpose of this report was to evaluate and document the authors' experience with sphincter pharyngoplasty in the mana
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An outcome evaluation of sphincter pharyngoplasty for the management of Velopharyngeal Insufficiency
2003Co-Authors: Albert Losken, J. Kerwin Williams, Fernando D. Burstein, Deonne Malick, John E. RiskiAbstract:Sphincter pharyngoplasty is frequently used for the management of children with Velopharyngeal Insufficiency. The purpose of this study was to evaluate outcome and revision rates of sphincter pharyngoplasty at the authors' institution. Two hundred fifty patients underwent sphincter pharyngoplasty for Velopharyngeal Insufficiency between January of 1987 and March of 2001. There were 117 female patients and 133 male patients, with a mean age at primary sphincter pharyngoplasty of 7.6 years (range, 1 to 45 years). Diagnoses included Velopharyngeal Insufficiency alone (n = 63), Velopharyngeal Insufficiency associated with cleft palate (n = 127), velocardiofacial syndrome (n = 32), submucous cleft (n = 15), and other (n = 13). Pharyngoplasty revision was defined as any secondary surgical revision of the sphincter as determined by clinical evaluation and objective speech assessment. The pharyngoplasty revision rate was found to be 12.8 percent (n = 32). A favorable outcome was demonstrated in 30 of these patients (93.8 percent) after pharyngoplasty revision. Two patients, one with a diagnosis of a submucous cleft and velocardiofacial syndrome and the other with a cleft palate, required a second revision because of persistent Velopharyngeal Insufficiency. The revision rate was highest in those patients with velocardiofacial syndrome (21.8 percent) and lowest in patients with Velopharyngeal Insufficiency alone (6.3 percent). Patients who required revision had significantly higher preoperative oral sentence nasometry (55.2 percent versus 46.1 percent; p < 0.01) and larger Velopharyngeal areas (23.7 mm 2 versus 18.9 mm 2 ). There was no significant difference in age or sex for those patients who required a revision compared with those who did not require revision. Mean follow-up was 2.4 years (range, 4 months to 13.6 years). Sphincter pharyngoplasty is an effective procedure for the treatment of Velopharyngeal Insufficiency using revision rate as the standard of success. It had an 87 percent primary success rate that increased to 99 percent after a single revision. Patients with velocardiofacial syndrome, more severe preoperative hypernasal resonance, and larger Velopharyngeal areas were mole likely to require pharyngoplasty revision.
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An outcome evaluation of sphincter pharyngoplasty for the management of Velopharyngeal Insufficiency.
Plastic and Reconstructive Surgery, 2003Co-Authors: Albert Losken, J. Kerwin Williams, Fernando D. Burstein, Deonne Malick, John E. RiskiAbstract:Sphincter pharyngoplasty is frequently used for the management of children with Velopharyngeal Insufficiency. The purpose of this study was to evaluate outcome and revision rates of sphincter pharyngoplasty at the authors’ institution. Two hundred fifty patients underwent sphincter pharyngoplasty fo
Anne M B Van Der Heul - One of the best experts on this subject based on the ideXlab platform.
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Velopharyngeal Insufficiency treated with levator muscle repositioning and unilateral myomucosal buccinator flap
Journal of Cranio-maxillofacial Surgery, 2017Co-Authors: Robrecht J H Logjes, Maaike T A Van Den Aardweg, Meike M J Blezer, Anne M B Van Der Heul, Corstiaan C. BreugemAbstract:Abstract Purpose Velopharyngeal Insufficiency (VPI) is common (20–30%) after cleft palate closure. The myomucosal buccinator flap has become an important treatment option for Velopharyngeal Insufficiency; however, published studies all use bilateral buccinator flaps. This study assesses outcomes with a unilateral myomucosal buccinator flap that might result in less operating time and might prevent the need of a bite block and an extra procedure for division of the flap pedicle at a later stage. Materials and methods Forty-two consecutive patients who underwent a unilateral myomucosal buccinator flap procedure were retrospectively reviewed. Overall clinical judgment of speech, speech analysis, and Velopharyngeal closure were evaluated by a multidisciplinary cleft palate team. Results Median follow-up was 1.2 years. In 83% of patients, overall clinical judgment of optimal speech was obtained and thus no further Velopharyngeal surgery was necessary. In 7 patients, further surgery was necessary, of whom 57% (4/7) had bilateral cleft lip−palate. Mean level of intelligibility improved significantly as evaluated by speech pathologists (2.5 ± 0.9 vs 3.5 ± 0.9; P Conclusion The unilateral myomucosal buccinator flap seems to be an effective and safe procedure and should become part of the armamentarium of cleft surgeons.
