Thursday, March 23, 2006
9879

Velar Motion and VPI Treatment Outcomes in 22q11.2 Deletion Syndrome

Rachel A. Ruotolo, MD, C. Francisco Espinel, MD, Cynthia B. Solot, MA, CCC, Donna M. McDonald-McGinn, MS, Elaine H. Zackai, MD, and Richard E. Kirschner, MD.

PURPOSE: To determine whether preoperative velar motion in 22q11.2 Deletion Syndrome determines speech outcome after VPI surgery.

METHODS: A retrospective review was conducted of 25 patients with 22q11.2 Deletion Syndrome and VPI. Velopharyngeal gap size and motion were examined preoperatively by nasendoscopy or videofluoroscopy. Gap size was designated as small/moderate (0-50% of resting VP area) or large (51-100%). Velar motion was defined as poor/fair (Group A) when motion contributed <50% to VP closure or good/excellent (Group B) when motion contributed to >50%.

RESULTS: Nineteen (76%) and seven (24%) patients were treated with a PPF and a sphincter pharyngoplasty, respectively. Velar motion was rated as poor/fair in 6 (24%) patients (Group A) and good/excellent in 19 (76%) patients (Group B). Large gaps were noted in 67% and 26% of patients in Group A and Group B, respectively.

Although the mean preoperative nasality score was higher in Group A than in Group B (3.6 vs. 2.5), this difference did not reach statistical significance. Postoperatively, the mean nasality score was .63 in Group A and .75 in Group B (p=NS).

CONCLUSIONS: Most 22q11.2 Deletion patients demonstrate good/excellent velar motion. Acceptable resonance may be achieved regardless of velar motion by individualizing surgical management.

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