Obturator Fabrication and Management for Velopharyngeal Insufficiency
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<bold>Purpose:</bold> Describe all patients referred for obturators to manage velopharyngeal insufficiency from January 1, 2001 to November 30, 2012 at Seattle Children's Hospital, looking at the following parameters of interest: demographics, medical diagnoses, surgical history, speech assessments and interventions, clinical course with obturator, and speech outcomes, and to explore variables which may predict success or suboptimal outcome with the pharyngeal obturator such as patient age, size of anatomic defect, degree of VP sphincter muscle function, or co-occurring medical diagnoses. <bold>Methods:</bold> This descriptive study involves a chart review of all patients who have undergone obturator fabrication at Seattle Children's Hospital from January 1, 2001 to November 30, 2012. <bold>Results:</bold> A total of 28 patients (13 males and 15 females) were managed in the obturator program over the study period. Most patients in this study are still active (67.8%); among active patients 75% are growing, and 25% have finished growing. Nine patients who are no longer active discontinued treatment due to: family decision (N=3), family move (N=2), VPI surgery (N=2), alternate therapy (N=1), or uncooperative behavior (N=1). Obturators resulted in improved speech for 92.9% (N=26) of patients with full resolution in 50.0% (N=14). Most patients in the obturator program had severe VPI (57.1%, N=16), while the remaining were moderate (14.3%, N=4) and mild (14.3%, N=4), with four patients uncategorized. The highest comorbidity for VPI was a craniofacial diagnosis (62%), with the most prevalent diagnoses being cleft palate (24%) and cleft lip and palate (14%). Obstructive sleep apnea (26%) and dysarthria (19%) were the most common non-craniofacial comorbidities. <bold>Conclusions:</bold> Wearing an obturator did not stimulate VP muscle function to eliminate or decrease VPI. Obturator management of VPI should be viewed as an ongoing treatment modality. The majority of patients with obturators were still in active status, even after craniofacial growth was complete. The best results were achieved in patients with an anatomical defect without intellectual disability. The patients with less successful outcomes were those with dysarthria, facial nerve weakness, intellectual disability, and mitochondrial cytopathy.
- Dentistry