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Management of Velopharyngeal Insufficiency in Cleft Patients With and Without Multidisciplinary Team Care

Vanessa Torrecillas1, Sarah Hatch Pollard1, Hilary McCrary1

  • 1Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA.

The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association
|October 5, 2020
PubMed

Insights

Multidisciplinary teams significantly improve velopharyngeal insufficiency (VPI) diagnosis and treatment in children with cleft palate. Team care increases VPI diagnosis rates and speech surgery, enhancing patient outcomes.

Area of Science:

  • Craniofacial surgery
  • Pediatric otolaryngology
  • Speech-language pathology

Background:

  • Velopharyngeal insufficiency (VPI) is a common complication following cleft palate repair.
  • Accurate diagnosis and timely intervention are crucial for managing VPI and improving speech outcomes.
  • The role of specialized multidisciplinary teams in optimizing VPI care requires further investigation.

Purpose of the Study:

  • To evaluate the impact of an American Cleft Palate-Craniofacial Association (ACPA)-approved multidisciplinary team on the diagnosis and treatment of VPI.
  • To compare VPI diagnosis and surgical rates between children managed by multidisciplinary teams and those receiving independent care.

Main Methods:

  • Retrospective cohort study of 940 children with cleft palate repair at a tertiary children's hospital.
  • VPI diagnosis based on surgeon or team assessment; data collected on age at diagnosis and surgery.
  • Statistical analysis included t-tests and multivariate regression to compare outcomes between team care and independent care groups.

Main Results:

  • Children managed by ACPA-approved teams had significantly higher rates of VPI diagnosis (38.8% vs. 10%) and speech surgery (21% vs. 10%) compared to those receiving independent care.
  • Team care was associated with a nearly 6-fold increase in VPI diagnosis.
  • Each team visit correlated with increased odds of VPI diagnosis and speech surgery, without affecting age at diagnosis or surgery.

Conclusions:

  • ACPA-approved multidisciplinary team care is associated with more accurate and frequent detection of VPI.
  • This improved diagnostic accuracy leads to increased VPI-related speech therapy and surgical interventions.
  • Further research is recommended to assess the quality of life implications of timely VPI diagnosis and optimize team care protocols.
Abstract

Keywords:
quality of lifespeech developmentspeech disordersvelopharyngeal function

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