Speech Outcomes After Clinically Indicated Posterior Pharyngeal Flap Takedown

Area of Science:

• Craniofacial Surgery
• Speech Pathology
• Pediatric Otolaryngology

Background:

• Velopharyngeal insufficiency (VPI) affects up to one-third of patients post-cleft palate repair.
• Posterior pharyngeal flap (PPF) surgery corrects VPI but can cause hyponasality and obstructive sleep apnea.
• PPF takedown may be necessary to address these complications.

Purpose of the Study:

• To evaluate if speech outcomes decline after clinically indicated posterior pharyngeal flap (PPF) takedown.
• To compare speech results between PPF takedown alone and PPF takedown with Furlow palatoplasty.

Main Methods:

• Retrospective query of a cleft-craniofacial database for patients undergoing PPF takedown.
• Comparison of preoperative and postoperative Pittsburgh Weighted Speech Scores (PWSS) using the Pittsburgh Weighted Speech Score (PWSS).
• Stratification and comparison of outcomes based on surgical method: PPF takedown alone vs. PPF takedown with Furlow palatoplasty.

Main Results:

• 64 patients underwent PPF takedown (18 alone, 46 with Furlow palatoplasty).
• No statistically significant regression in PWSS was observed for either surgical group.
• Approximately 90% of patients undergoing PPF takedown alone showed no significant speech reduction.

Conclusions:

• Clinically indicated posterior pharyngeal flap (PPF) takedown does not lead to significant speech regression.
• Concerns about speech degradation after PPF takedown are not supported by these findings.
• PPF takedown is a safe option for managing complications while preserving speech.