Source: Wolters Kluwer Health: Lippincott Williams & Wilkins

Released: Mon 16-Jun-2008, 16:00 ET  Embargo expired: Mon 16-Jun-2008, 00:00 ET  Printer-friendly Version

Insights into Velopharyngeal Dysfunction

Newswise — For infants with cleft palate, properly timed, individualized surgery to repair the defect can prevent lifelong speech and other problems resulting from velopharyngeal dysfunction (VPD), according to a special article in the May issue of The Journal of Craniofacial Surgery. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

Early, well-designed surgery—performed before the infant reaches critical stages in speech development—can prevent speech impediments and other functional problems related to VPD, as well as avoiding the need for repeated surgeries, according to an introductory article by Mutaz B. Habal, M.D., and Jane Scheurle, Ed.D., of Tampa Bay Craniofacial Center in Tampa, Fla. "The timing of cleft palate repair is most important in the functional outcome of patients," comments Dr. Habal, who is also Editor-in-Chief of JCS.

Patients with VPD have an abnormal opening between the mouth and nasal cavity. This anatomical abnormality leads to functional problems, especially in speech and communication. Although other causes are possible, the most common cause of VPD is failed cleft palate surgery. Even today, surgery may fail to fully close the cleft palate in up to 25 percent of cases.

Some patients undergo additional surgeries in an attempt to correct the inadequate initial repair—sometimes making the problem worse. At their specialty center, Dr. Habal's team sees patients with VPD across the age span—including not only infants but also adults dealing with lifelong speech, swallowing, and other problems related to failed cleft palate surgery.

Timely Surgery Is Key to Prevention
For Dr. Habal, a key step in his development as a surgeon was understanding the "critical window of time" for the development of normal speech in infants. Performing surgery before this time—specifically, between age 3 and 6 months—fixes the anatomical problem so that speech can develop normally. "Following this paradigm of early intervention, the babies develop normal and typical velopharyngeal function, acquire speech and language, and bypass the need for traditional speech resonance diagnostic and treatment therapies," Drs. Habal and Scheurle write.

In addition to appropriate timing, other important issues include an individualized approach to surgical planning and an understanding of the critical relationship between hearing and speech. Patients with VPD may have other congenital and acquired defects as well, leading to problems with hearing, feeding, and socialization that also need to be addressed.

The special section of the May JCS includes several papers offering new surgical insights relevant to surgery for patients affected by VPD. At Tampa Bay Craniofacial Center, the emphasis is on early surgery to repair the cleft palate before the child is 6 months old. (Cleft lip, if present, is repaired even earlier—between one and two weeks.) Close follow-up is essential to monitor the child's hearing, as well as the development of normal communication between the parents and child.

In Dr. Habal's experience of more than 30 years including nearly 1,000 infants with cleft palate, this approach has produced excellent results. Only eight percent of children have required speech therapy, while just one has needed a repeat surgical procedure. "With these results…we have come to believe that like early cleft closure, early prespeech, multidimensional intervention that guides the infant’s intraoral and oropharyngeal muscle habituation coincides with the critical window of time for early neurogenesis and neuromuscular integration," Drs. Habal and Scheurle conclude.

"Speech is a learned skill more dependent on cognition than on the type of surgical repair," Dr. Habal adds. "Early surgery provides the child with an anatomic repair to help his or her cognition as the child is acquiring the skill of language expression, so the timing is more important than the different repairs done."

About The Journal of Craniofacial Surgery
The Journal of Craniofacial Surgery (www.jcraniofacialsurgery.com) serves as a forum of communication for all those involved in craniofacial and maxillofacial surgery. Coverage ranges from practical aspects of craniofacial surgery to the basic science that underlies surgical practice. Affiliates include 13 major specialty societies around the world, including the American Association of Pediatric Plastic Surgeons, the American Academy of Pediatrics Section of Pediatric Plastic Surgery, the American Society of Craniofacial Surgeons, the American Society of Maxillofacial Surgeons, the Argentine Society of Plastic Surgery Section of Pediatric Plastic Surgery, the Asian Pacific Craniofacial Association, the Brazilian Society of Craniofacial Surgeons, the European Society of Craniofacial Surgery, the International Society of Craniofacial Surgery, the Japanese Society of Craniofacial Surgery, the Korean Society of Craniofacial Surgery, the Thai Cleft and Craniofacial Association, and the World Craniofacial Foundation.

About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (www.LWW.com) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

Wolters Kluwer Health is a division of Wolters Kluwer, a leading global information services and publishing company with annual revenues (2007) of €3.4 billion ($4.8 billion), maintains operations in over 33 countries across Europe, North America, and Asia Pacific and employs approximately 19,500 people worldwide. Visit www.wolterskluwer.com for information about our market positions, customers, brands, and organization.