Velopharyngeal insufficiency following cleft palate repair: a comparative effectiveness study of existing surgical procedures and identification of criteria to guide a personalized treatment approach Grant uri icon

abstract

  • Our long-term goal is to develop and implement a precise, personalized approach for treating VPI in children with cleft palate that selects an operation based on the specific cause of VPI. This proposal?s overall objectives are to (1) establish criteria for identifying children who can be effectively treated by re-repair and (2) identify barriers and facilitators to implementing personalized VPI procedure selection. Our central hypothesis is that, for children who exhibit specific anatomic abnormalities after their cleft palate repair (i.e., velar muscle dehiscence, velar muscle malposition, or a short velum), re-repair and pharyngoplasty are equally effective at resolving VPI symptoms. This is based on literature showing that restoring velar muscle anatomy13,15 and improving velar length16,17 can resolve hypernasality and audible nasal emission and our preliminary findings that abnormal muscle anatomy is present in 58% of children with VPI after palate repair. Our rationale is that identifying children with VPI who will benefit from re-repair and performing re-repair rather than pharyngoplasty in those children will resolve VPI symptoms without the risk of OSA. We propose three specific aims: Aim 1: Compare the effectiveness of palate re-repair with that of pharyngoplasty for treating VPI. Hypothesis: Palate re-repair is not inferior to pharyngoplasty for resolving hypernasality. Aim 2: Determine the anatomic abnormalities of the palate that predict resolution of hypernasality following palate re-repair and the abnormalities that predict superior outcomes after pharyngoplasty. Hypothesis: Velar muscle dehiscence, velar muscle malposition, and/or a short velum, as visualized on pre-operative magnetic resonance imaging (MRI), predicts resolution of hypernasality following palate re-repair. Aim 3: Identify barriers and facilitators to implementing personalized VPI procedure selection. Completion of these aims will provide the first direct comparison of palate re-repair to pharyngoplasty for the treatment of VPI; establish the morphologic and anatomic features that predict successful treatment with each procedure; and identify barriers and facilitators to implementing personalized VPI procedure selection. At the completion of this study, we will have produced a significant positive impact for children with VPI following cleft palate repair by enabling surgeons to select the most effective, least harmful VPI procedure for each child.

date/time interval

  • July 2020 - June 2026