Surgical outcomes and revision rates for velopharyngeal insufficiency (VPI) in syndromic and non-syndromic children: A systematic review and meta-analysis

Evan S Chernov; April N Taniguchi; Shaun A Nguyen; Sarah R Sutton; Phayvanh P Pecha; Krishna G Patel; Melissa Montiel; William W Carroll

doi:10.1016/j.amjoto.2024.104341

Surgical outcomes and revision rates for velopharyngeal insufficiency (VPI) in syndromic and non-syndromic children: A systematic review and meta-analysis

Am J Otolaryngol. 2024 May 1;45(4):104341. doi: 10.1016/j.amjoto.2024.104341. Online ahead of print.

Authors

Evan S Chernov¹, April N Taniguchi², Shaun A Nguyen³, Sarah R Sutton⁴, Phayvanh P Pecha⁵, Krishna G Patel⁵, Melissa Montiel⁶, William W Carroll⁵

Affiliations

¹ Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, 135 Rutledge Avenue, Charleston, SC 29425, USA; SUNY Upstate Medical University, School of Medicine, 766 Irving Ave, Syracuse, NY 13210, USA.
² Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, 135 Rutledge Avenue, Charleston, SC 29425, USA; University of Central Florida, School of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA.
³ Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, 135 Rutledge Avenue, Charleston, SC 29425, USA. Electronic address: nguyensh@musc.edu.
⁴ Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, 135 Rutledge Avenue, Charleston, SC 29425, USA; University of Nevada, Reno, School of Medicine, 1664 N Virginia St, Reno, NV 89557, USA.
⁵ Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, 135 Rutledge Avenue, Charleston, SC 29425, USA.
⁶ Medical University of South Carolina, Department of Speech Language Pathology, 135 Rutledge Avenue, Charleston, SC 29425, USA.

PMID: 38754293
DOI: 10.1016/j.amjoto.2024.104341

Abstract

Purpose: To evaluate pre- and post-operative resonance, surgical technique, revision rate, and revision indication among syndromic and non-syndromic children with velopharyngeal insufficiency (VPI).

Materials and methods: A systematic review was conducted through July 2022. Children surgically treated for VPI were included. A meta-analysis of single means, proportions, comparison of proportions, and mean differences with 95 % confidence interval [CI] was conducted.

Results: Twenty-three articles (n = 1437) were included in the analysis. The most common surgery was Sphincter Pharyngoplasty (SP), 62.6 % [31.3-88.9] for syndromic and 76.3 % [37.5-98.9] for non-syndromic children. Among all surgical techniques, for syndromic and non-syndromic children, 54.8 % [30.9-77.5] and 73.9 % [61.3-84.6] obtained normal resonance post-operatively, respectively. Syndromic patients obtained normal resonance post-operatively in 83.3 % [57.7-96.6] of Combined Furlow Palatoplasty and Sphincter Pharyngoplasty (CPSP), 72.6 % [54.5-87.5] of Pharyngeal Flap (PF), and 45.1 % [13.2-79.8] of Sphincter Pharyngoplasty (SP) surgeries. Non-syndromic patients obtained normal resonance post-operatively in 79.2 % [66.4-88.8] of PF and 75.2 % [61.8-86.5] of SP surgeries. The revision rate for syndromic and non-syndromic patients was 19.9 % [15.0-25.6] and 11.3 % [5.8-18.3], respectively. The difference was statistically significant, 8.6 % [2.9-15.0, p = 0.003]. Syndromic patients who underwent PF were least likely to undergo revision surgery as compared to SP and CPSP, 7.7 % [2.3-17.9] vs. 23.7 % [15.5-33.1] and 15.3 % [2.8-40.7], respectively.

Conclusions: Syndromic children had higher revision rates and were significantly less likely to obtain normal resonance following primary surgery than non-syndromic patients. Among syndromic children, PF and CPSP have been shown to improve resonance and reduce revision rates more so than SP alone.

Keywords: Non-syndromic; Pediatric; Resonance; Surgery; Syndromic; Velopharyngeal insufficiency.