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Pediatric Surgery

OMS and Other Dental Specialists

Session: Pediatrics Track: Hot-off-the-Press and Abstract Session

GP2b - An Evaluation of Rapid Palatal Expansion on Velopharyngeal Insufficiency and Speech Outcomes

Thursday, September 12, 2024
11:25 AM – 11:35 AM EDT
Location: Tangerine Ballroom WF1, Orange County Convention Center

    Oral Abstract Presenter(s)

  • VM

    Valeria Mejia, B.S.

    Medical Student
    Children's Hospital Los Angeles
    Los Angeles, California

  • Marah Jolibois, MS (she/her/hers)

    Research Fellow
    Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
    Los Angeles, California

    • Co-Author(s)

  • CT

    Collean Trotter, BS, MAT

    Research Fellow
    Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA
    Los Angeles, California

  • Idean Roohani, BS

    Research Fellow
    Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
    Los Angeles, California

  • Sasha Lasky, BS

    Research Fellow
    Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
    South Pasadena, California

  • Tayla Moshal

    Research Fellow
    Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
    Los Angeles, California

  • MU

    Mark M. Urata, DDS, MD

    Plastic Surgeon Attending
    Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles
    Los Angeles, California

  • WM

    William P. Magee, III, DDS, MD

    Plastic Surgeon Attending
    Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles
    Los Angeles, California

  • Jeffrey A. Hammoudeh, DDS, MD

    Plastic Surgeon Attending
    Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles
    Los Angeles, California

Background: Cleft palate frequently leads to velopharyngeal insufficiency (VPI), resulting in poor speech outcomes.1 Rapid palate expansion (RPE) is an orthodontic intervention used to address maxillary arch constriction in patients with a history of cleft palate2, however, the impact of RPE on speech and its role as a precursor to VPI surgery remain underexplored. This study investigates the influence of RPE on speech outcomes in cleft palate patients and its association with the need for subsequent VPI surgery.

Methods: This is a retrospective review of all patients who underwent palatoplasty from 2003-2023. Nonsyndromic patients with unilateral cleft lip and palate (Veau III) who underwent subsequent RPE and had at least 3 years of follow-up were included in the study. Patients were classified as having a narrow maxilla and received palate expansion surgically or nonsurgically. Variables including cleft characteristics, repair type, fistula repair, speech corrective surgery and orthodontic evaluation and interventions were collected. Our primary outcome was the need for speech correcting surgery to correct velopharyngeal insufficiency following palate expansion. VPI surgery rates were compared between the palatal expansion cohort and patients with cleft palate. A multivariate logistic regression was performed assessing the need for VPI Surgery controlling for sex, age at palatoplasty, repair technique, fistula formation, surgeon experience, and palate expansion.

Results: In total, 1,557 patients underwent palatoplasty of which 479 met inclusion criteria and 165 underwent palate expansion. The overall VPI surgical rate for or Veau III patients who underwent palatoplasty was 13.7%. Patients who underwent palate expansion were associated with significantly increased VPI surgery rates compared to patients who did not undergo palate expansion (23.8% vs 9.2%, P = .009). By logistic regression, an older age at palatoplasty (Odds Ratio [OR] 1.010, P = .046) and palate expansion (OR: 1.122, P = .029) were more likely to undergo VPI surgery.

Conclusion: Veaux III patients who undergo palate expansion are more likely to have speech correction surgery following their orthodontic intervention. When counseling patients with Veau III clefts requiring palate expansion should be advised of the increased likelihood of the need for speech correcting surgery.

1. Pitkanen, Veera V. PhD, MD*; Geneid, Ahmed PhD, MD†; Saarikko, Anne M. PhD, MD*; Hakli, Sanna PhD, MD‡; Alaluusua, Suvi A. PhD, MA*. Diagnosing and Managing Velopharyngeal Insufficiency in Patients With Cleft Palate After Primary Palatoplasty. The Journal of Craniofacial Surgery ():10.1097/SCS.0000000000009822, November 13, 2023. | DOI: 10.1097/SCS.0000000000009822
2. Stevens K, Bressmann T, Gong SG, Tompson BD. Impact of a rapid palatal expander on speech articulation. Am J Orthod Dentofacial Orthop. 2011 Aug;140(2):e67-75. doi: 10.1016/j.ajodo.2011.02.017. PMID: 21803236.