الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
One of the often-stated goals of cleft care is to establish normal speech. Despite best attempts, primary palatal management does not achieve normal speech in all individuals with cleft palate. That is, 5%- 45% of children born with cleft palate will require secondary surgeries to manage VPD.
Perceptual and instrumental speech assessment of VP function are available for differential diagnosis of the VPD and consequently formulating a treatment plan tailored for each case. Available treatment options for VPI include speech therapy, prosthetic devices, and surgical management. Surgical treatment includes, palatal techniques and pharyngeal techniques.
Palatal techniques include; re: IVV, DOZ and palatal lengthening by BMMF. Pharyngeal techniques include; PF, SPP and PWA. A combination of these techniques is also reported in literature; either as a single or multiple stages. Since, a wide array of surgical techniques is available for treatment of VPI in patients with CP, a treatment algorithm to guide the surgical treatment is much needed.
Therefore, the aim of this study was to review current literature regarding the speech outcome of different techniques of surgical treatment of VPD in cleft patients, in an attempt to reach a treatment algorithm.
A systematic review was done, by searching Pubmed, Scopus and Web of Science electronic databases, following the PRISMA guidelines, for articles reporting secondary VPI surgeries on non- syndromic patients with CP. Application of the pre-set selection criteria throughout the screening process, yielded 25 articles, with a total of 5 algorithms, reported in these articles. Articles were categorized the surgical technique used. Raw data was extracted to compare speech outcome and complication of each technique, with special emphasis on the factors affecting, the patients’ selection for each technique.
Our results showed comparable success and complication rates among these techniques. However, it is not the comparison between techniques that matters, since the indications of each technique differ. The factors governing selection of each technique, should be rather taken into consideration.
Based on the results of our review, successful management of VPI in patients with CP, is dependent on:
Pre- operative assessment, should include speech and airway risk assessment. Speech assessment should include PSA and instrumental assessment by multiview VF and NPE. In cases with high airway risk a polysomnogram should be done, in cases with low risk, a validated questionnaire should be used.
Follow-up period should allow for complete recovery for reliable results. In the PF techniques, it is agreed to wait a minimum of 6 months. However, in the palatal techniques a minimum period of 12 months is recommended.
Speech therapy plays an important role in the postoperative speech outcome.
The most important factors affecting the technique choice are:
VP gap size.
Palatal length/ pharyngeal depth.
The LVP position.
Palatal mobility.
Palatal scarring.
VP closure pattern.
Age of the patient.
In borderline cases, where there is doubt that the less invasive technique might not achieve the speech outcome desired, a combined or staged approach can be sought. So far, there are no clear indications for either in the literature.