- Email: [email protected]
Commentary: Treating submucous clefts with a double-opposing Z-plasty
Accepted Manuscript Treating submucous clefts with a double-opposing Z-plasty C.C. Breugem, MD PhD PII:
S1748-6815(17)30058-X
DOI:
10.1016/j.bjps.2017.02.001
Reference:
PRAS 5222
To appear in:
Journal of Plastic, Reconstructive & Aesthetic Surgery
Received Date: 30 January 2017 Accepted Date: 2 February 2017
Please cite this article as: Breugem C, Treating submucous clefts with a double-opposing Z-plasty, British Journal of Plastic Surgery (2017), doi: 10.1016/j.bjps.2017.02.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Treating submucous clefts with a double-opposing Z-plasty
RI PT
CC Breugem MD PhD Pediatric Plastic Surgeon Wilhelmina Children’s Hospital University of Utrecht PO Boc 85090 3508 AB Utrecht The Netherlands
AC C
EP
TE D
M AN U
SC
e-mail: [email protected]
ACCEPTED MANUSCRIPT Baek et al describe that the double-opposing Z-plasty could be a very valuable technique to treat hypernasality in submucous clefts1. Although this study is a valuable adjunct to the cleft literature, some factors need attention. The authors demonstrate that numerous patients still had articulation problems. The speech was analysed by plastic surgeons and although I am
RI PT
fully aware that some surgeons are able in doing this, for future studies I would suggest that the speech and articulation should be analysed by speech- and language pathologists.
SC
Furthermore, it is unclear if patients had any form of speech therapy after surgery.
However, this study also demonstrates the paucity of information we have about this
M AN U
relatively rare form of oral clefts and brings up several questions that should be answered in future studies. To consistently compare and report outcome data, I agree with Gosain et al that patients with an overt cleft of the secondary palate that extends beyond the uvula should be reported as having a cleft palate, and not a submucous cleft palate, even if a submucous cleft
TE D
exists in a portion of the palate anterior to the overt cleft2. Future studies should explore the incidence of otitis media with effusion in the presence of submucous cleft palate since this could also influence speech outcome. Although Baek et al demonstrated good results after a
EP
Furlow plasty 1, we know little about the lateral wall motion and future studies should emphasize if this is present. A study from Sullivan et al repoted that normal or borderline
AC C
competent velopharyngeal function was achieved only in 67% following double-opposing Zpalatoplasty, while this was found in 92% following pharyngeal flap surgery3. This demonstrated the importance to have adequate lateral pharyngeal wall movement to achieve velopharyngeal function after a Furlow plasty.
To objectively compare the outcomes of different surgical techniques, future studies should be prospective and utilize uniform means of analysis. These criteria should include at least
ACCEPTED MANUSCRIPT preoperative and postoperative perceptual speech assessments performed by trained speech pathologists and preoperative videofluoroscopy and nasopharyngoscopy.
AC C
EP
TE D
M AN U
SC
RI PT
The author received no funding and there is no conflict of interest. He has no declarations to make.
ACCEPTED MANUSCRIPT References: 1.Baek R-M, Kim B-K, Jeong JH, Ahn T, Han J. The effect of age at surgery and compensatory articulation on speech outcome in submucous cleft palate patients treated with double-opposing Z-plasty: A 10-year experience
RI PT
2. Gosain AK, Conley SF, Marks S, Larson DL. Submucous cleft palate: Diagnostic methods and outcomes of surgical treatment. Plast Reconst Surg. 1996;97(7):1497-1509.
AC C
EP
TE D
M AN U
SC
3. Sullivan SR, Vasudavan S, Marrinan EM, Mulliken JB. Submucous cleft palate and velopharyngeal insufficiency: Comparison of speech outcomes using three operative techniques by one surgeon. Cleft Palate Craniofac J. 2011;48:561–570.
S1748-6815(17)30058-X
DOI:
10.1016/j.bjps.2017.02.001
Reference:
PRAS 5222
To appear in:
Journal of Plastic, Reconstructive & Aesthetic Surgery
Received Date: 30 January 2017 Accepted Date: 2 February 2017
Please cite this article as: Breugem C, Treating submucous clefts with a double-opposing Z-plasty, British Journal of Plastic Surgery (2017), doi: 10.1016/j.bjps.2017.02.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Treating submucous clefts with a double-opposing Z-plasty
RI PT
CC Breugem MD PhD Pediatric Plastic Surgeon Wilhelmina Children’s Hospital University of Utrecht PO Boc 85090 3508 AB Utrecht The Netherlands
AC C
EP
TE D
M AN U
SC
e-mail: [email protected]
ACCEPTED MANUSCRIPT Baek et al describe that the double-opposing Z-plasty could be a very valuable technique to treat hypernasality in submucous clefts1. Although this study is a valuable adjunct to the cleft literature, some factors need attention. The authors demonstrate that numerous patients still had articulation problems. The speech was analysed by plastic surgeons and although I am
RI PT
fully aware that some surgeons are able in doing this, for future studies I would suggest that the speech and articulation should be analysed by speech- and language pathologists.
SC
Furthermore, it is unclear if patients had any form of speech therapy after surgery.
However, this study also demonstrates the paucity of information we have about this
M AN U
relatively rare form of oral clefts and brings up several questions that should be answered in future studies. To consistently compare and report outcome data, I agree with Gosain et al that patients with an overt cleft of the secondary palate that extends beyond the uvula should be reported as having a cleft palate, and not a submucous cleft palate, even if a submucous cleft
TE D
exists in a portion of the palate anterior to the overt cleft2. Future studies should explore the incidence of otitis media with effusion in the presence of submucous cleft palate since this could also influence speech outcome. Although Baek et al demonstrated good results after a
EP
Furlow plasty 1, we know little about the lateral wall motion and future studies should emphasize if this is present. A study from Sullivan et al repoted that normal or borderline
AC C
competent velopharyngeal function was achieved only in 67% following double-opposing Zpalatoplasty, while this was found in 92% following pharyngeal flap surgery3. This demonstrated the importance to have adequate lateral pharyngeal wall movement to achieve velopharyngeal function after a Furlow plasty.
To objectively compare the outcomes of different surgical techniques, future studies should be prospective and utilize uniform means of analysis. These criteria should include at least
ACCEPTED MANUSCRIPT preoperative and postoperative perceptual speech assessments performed by trained speech pathologists and preoperative videofluoroscopy and nasopharyngoscopy.
AC C
EP
TE D
M AN U
SC
RI PT
The author received no funding and there is no conflict of interest. He has no declarations to make.
ACCEPTED MANUSCRIPT References: 1.Baek R-M, Kim B-K, Jeong JH, Ahn T, Han J. The effect of age at surgery and compensatory articulation on speech outcome in submucous cleft palate patients treated with double-opposing Z-plasty: A 10-year experience
RI PT
2. Gosain AK, Conley SF, Marks S, Larson DL. Submucous cleft palate: Diagnostic methods and outcomes of surgical treatment. Plast Reconst Surg. 1996;97(7):1497-1509.
AC C
EP
TE D
M AN U
SC
3. Sullivan SR, Vasudavan S, Marrinan EM, Mulliken JB. Submucous cleft palate and velopharyngeal insufficiency: Comparison of speech outcomes using three operative techniques by one surgeon. Cleft Palate Craniofac J. 2011;48:561–570.