Pharyngeal Flaps & Obturator Use for Children with 22q.11

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Answer

Pharyngeal flaps for surgery continue to be the most commonly done surgery for treatment of VPD in children with 22q.  Some centers tend to believe that this has a higher success rate than other surgical options.  We do pharyngeal flaps on children with history of cardiac defects all the time.  As with any surgery, the physicians have to get clearance from the cardiology providers in order to proceed.  Often we will get a sleep study on patients if they have any airway concerns prior to the procedure.  In fact many places will actually have tonsils and adenoids removed before pharyngeal flap surgery to help lessen the risk of further airway obstruction. We know with any pharyngeal flap surgery there is always (although small) a risk of obstructive sleep apnea.  In terms of speech prostheses - we do not routinely use these but I do think that they are a good treatment option for children who cannot have surgery or where families do not want surgery for their child.  I think you need to have them made by a prosthodontist who is extremely patient with challenging pediatric patients.  And often it is a palatal lift that is the better fit as opposed to an obturator because many of them do have enough palate tissue it just doesn't move as well.  

Adriane Baylis, Ph.D., CCC-SLP, is Speech Scientist and Speech-Language Pathologist for the Section of Plastic and Reconstructive Surgery at Nationwide Children's Hospital (Columbus, OH). Dr. Baylis serves as Co-Director of the 22q Center at Nationwide Children’s Hospital and also provides clinical services to the Cleft Lip and Palate Center.