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Speech Outcomes with Acellular Dermal Matrix in Primary Palatoplasty
Darren M. Smith, MD, Sanjay Naran, MD, Matthew Ford, MS, CCC-SLP, Lisa Vecchione, DMD, MDS, James J. Cray, PhD, S. Alex Rottgers, MD, Michael R. Bykowski, BS, Brett Michelotti, MD, Christopher R. Kinsella, MD, Joseph E. Losee, MD.
University of Pittsburgh, Pittsburgh, PA, USA.

BACKGROUND
Success in palatoplasty is primarily defined as correction of velopharyngeal incompetence to provide an anatomical basis for normalized speech. However, failure to achieve a tension-free watertight closure invites the development of post operative palatal fistulas. We have minimized postoperative fistula rates by employing acellular dermal matrix (ADM) in difficult primary palatoplasties. We now hypothesize that the incorporation of ADM into primary Furlow palatoplasty does not compromise postoperative speech.
METHODS
We performed a retrospective review of consecutive patients undergoing primary Furlow palatoplasty with or without ADM at a major academic cleft-craniofacial center over 5 years (2004-2009) by a single surgeon. Patients with syndromic diagnoses and children under 2.75 years of age at palatoplasty (due to an inability to reliably quantify speech outcomes) were excluded. Demographics, Veau type, and speech results [quantified by Pittsburgh Weighted Speech Score (PWSS)] were obtained. Postoperative speech scores were compared between the ADM and non-ADM groups.
RESULTS
Speech outcomes were available for 53 consecutive patients that met inclusion criteria (ADM n = 32, non-ADM n = 21). Average follow-up was 3.6 years (0.9-6.2).The cohorts were not statistically different by age (T-test p > 0.05) or gender (Chi-square p > 0.05). Patients with more severe Veau diagnoses were more likely to be treated with ADM (Chi-square p < 0.001). The mean post-operative PWSS in the ADM group was 3.25 (range 0-26) and 4.6 (range 0-24) in the non-ADM group. There was no significant difference in post-operative PWSS between the ADM and non-ADM group (Kruskal-Wallis p > 0.05).
CONCLUSIONS
We have previously shown that ADM facilitates effective palatal closure in difficult primary palatoplasties and prevents postoperative fistulas. Here, we show that ADM does not appear to adversely affect speech outcomes in primary Furlow palatoplasty. In fact, speech outcomes were similar between ADM and non-ADM groups despite the ADM group’s including more severe clefts. Therefore, it seems that concerns for possible speech disturbance should not deter one from using ADM to augment primary Furlow palatoplasties that may otherwise seem tenuous.


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