65 / 232
(Fig. 2). For patients undergoing PPF takedown with conversion to
Furlow palatoplasty, PWSS significantly improved postoperatively
(3.1 ± 4.1 [range, 0
–
27]) compared to preoperative PWSS (6.4 ± 6.7
[range, 0
–
26]). When stratified by surgical intervention, no significant
deterioration in postoperative PWSS occurred (
P
= 0.79).
No surgical complications occurred after PPF takedown. Sixteen
(25.0%) patients had deterioration in PWSS after PPF takedown (n = 10
[55.6%] in the PPF takedown alone group versus 6 [13.0%] in the
conversion to Furlow palatoplasty group) (Table 2). For patients whose
speech deteriorated, mean deterioration in PWSS was 2.8 ± 1.8 (range,
1
–
7) (Fig. 3). For patients who had deterioration after PPF takedown
alone, mean deterioration in PWSS was 3.0 ± 2.2 (range, 1
–
7). For
patients who had deterioration after PPF takedown with conversion to
Furlow palatoplasty, the mean deterioration in PWSS was 2.2 ± 1.3
(range, 1
–
4). Two patients (3.1%) in the study, representing 11.1% of
the PFF takedown alone cohort, experienced
clinically
significant
(defined as affecting intelligibility) deterioration in PWSS that required
further speech resonance surgery after PPF takedown. These patients
(patients 8 and 14) (Table 2) progressed to delayed conversion to
Furlow palatoplasty. No patients required readmission for surgical-
related or OSA-related complications after PPF takedown or PPF
takedown with conversion to Furlow palatoplasty.
DISCUSSION
This study suggests clinically indicated PPF takedown results in
minimal deleterious speech outcomes, highlighting its potential effi-
cacy in the treatment of PPF-related OSA. The retrospective nature of
the study results in potential limitations that must be addressed. Speech
pathologists were not blinded to their patients, which may introduce a
degree of rater bias when comparing preoperative and postoperative
speech scores. Additionally, although blinded listener ratings of preop-
erative and postoperative speech samples do not exist, the speech rating
reliability of the institution's speech pathologists has been previously
validated and published.
21
Additionally, as our institution did not
perform all initial surgeries, data regarding the initial PPF surgeries
remain inaccessible. However, based on chart reviews from the authors'
institution, all PPFs were in place for at least 5 years before takedown.
Additionally, the mean age at takedown in this study was 12.4 years,
and most PPFs are placed when the child is between the ages of
3 and 4 years. Thus, we can conclude that the flaps in this study were
in place for at least 5 years and on average closer to 10 years.
The OSA rates have been reported to be as high as 30% after
PPF surgery.
4,12,19,22,23
The proper treatment of OSA in these patients
is controversial, and there is no established treatment algorithm or
FIGURE 3.
Change in PWSS for the 16 patients who had a
regression in PWSS following PPF takedown. A positive score
indicates a regression in PWSS from pre-takedown
to post-takedown.
TABLE 2.
Patients Who Had a Regression in PWSS After PPF Takedown
Pt
Pretakedown
PWSS
Posttakedown
PWSS
Delta
PWSS
Reason for
Takedown Sex
Age at
Takedown, y
Surgery
Additional Speech
Surgery (Operation: PWSS
Postoperatively)
Follow-up,
mo
1
3
5
2 OSA/Lefort
I
Male
16 PPF takedown +
Conversion Furlow
No
29
2
2
5
3
OSA Male
15 PPF takedown +
Conversion Furlow
No
26
3
3
4
1
OSA Female
10 PPF takedown +
Conversion Furlow
No
53
4
0
1
1
Recurrent
VPI
Male
9 PPF takedown +
Conversion Furlow
No
49
5
23
27
4
OSA Male
17 PPF takedown +
Conversion Furlow
No
28
6
0
3
3 OSA/Lefort
I
Male
20 PPF takedown +
Conversion Furlow
No
55
7
0
4
4
OSA Female
19 Takedown alone
No
10
8
0
7
7
OSA Male
11 Takedown alone
Yes (delayed conversion
Furlow Palatoplasty: 3)
60
9
0
3
3 OSA/hyponasal Female
10 Takedown alone
No
78
10
0
3
3
OSA Female
12 Takedown alone
No
16
11
0
1
1
OSA Male
8 Takedown alone
No
53
12
0
1
1
OSA Male
15 Takedown alone
No
1
13
0
3
3
OSA Female
9 Takedown alone
No
19
14
4
10
6 OSA/hyponasal Female
7 Takedown alone
Yes (delayed conversion
Furlow Palatoplasty: 4)
104
15
2
3
1
OSA Male
19 Takedown alone
No
2
16
3
4
1
OSA Male
11 Takedown alone
No
2
Katzel et al
Annals of Plastic Surgery
•
Volume 77, Number 4, October 2016
www.annalsplasticsurgery.com© 2015 Wolters Kluwer Health, Inc. All rights reserved.
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