The Effects of Gravity and Scar Contracture on Post-Surgical Tissue Changes and Speech Outcomes Following Pharyngoplasties

ECU Author/Contributor (non-ECU co-authors, if there are any, appear on document)

Kazlin N. Mason (Creator)

Institution

East Carolina University (ECU )

Web Site: http://www.ecu.edu/lib/

Abstract: Following cleft palate repair , approximately 20% of patients continue to display velopharyngeal dysfunction (VPD) and require secondary surgery. Those with VPD are more likely to develop aberrant speech errors , affecting communication abilities across the lifespan. The goal of secondary surgery is to create a narrowing of the velopharyngeal space that allows for improved speech and resonance , but avoids airway morbidity. To reduce failure rate , inserting the sphincter pharyngoplasty flaps to the height of attempted velopharyngeal contact has been advised. However , surgical failure is prevalent and post-operative assessment frequently reveals low-set pharyngoplasties. It remains unknown the extent to which post-operative tissue migration occurs and how this migration influences speech outcomes. There is a need to examine the initial placement and subsequent movement of the pharyngoplasty within the nasopharyngeal airway. A series of investigations were designed to explore and validate the use of imaging methodologies to assess post-surgical tissue changes secondary to pharyngoplasties and their effects on speech outcomes. Study I aimed to validate the use a reference line to quantify the vertical distance between the height of velopharyngeal closure and C1 as well as to provide data for how this distance changes across a typically developing child population. Study II focused on the application of data provided from Study I to a disordered population which included varying diagnoses of cleft palate from childhood through adolescence. Study III developed a method to volumetrically assess the nasopharyngeal airway utilizing 3D MR imaging and computer modeling. Results from this study provided insight into the integration and applicability of the use of 3D visualization of the velopharyngeal mechanism for identification of post-surgical changes in subjects following pharyngoplasty. Study IV applied the methodologies established in studies I , II , and III to comprehensively examine post-surgical tissue changes relative to the bony cervical landmarks and correlate post-surgical tissue changes to speech outcomes following pharyngoplasties. Data from study IV confirms that inferior tissue displacement of the pharyngoplasty occurs post-operatively. Significant differences were present between the initial site of pharyngoplasty tissue insertion and the final pharyngoplasty location 2-4 months post-operatively. Pharyngoplasties located below the level of C1 resulted in poorer perceptual and quantitative measures of speech. Gravity , scar contracture , and patient-specific variables likely interact , impacting the final post-operative pharyngoplasty location.

Additional Information

Publication

Dissertation

Language: English

Date: 2017

Keywords

cleft palate, pharyngoplasty, magnetic resonance imaging, velopharyngeal dysfunction

Subjects

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