A Master Mind Game Code Algorithm Approach to Help Surgical Decision-Making between Retropharyngeal Fat Grafting and Pharyngoplasty for the Treatment of Velopharyngeal Incompetence

• Published in: International Archives of Otorhinolaryngology Vol. 27; no. 2; pp. e351 - e361
• Main Authors: Suzzi, Chiara, Di Gennaro, Gianfranco, Baylon, Hélène, Captier, Guillaume
• Format: Journal Article
• Language: English
• Published: Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil Thieme Revinter Publicações Ltda 01-04-2023; Thieme Revinter Publicações Ltda., Brazil; Fundação Otorrinolaringologia
• Subjects: autologous; clinical decision-making; inadequate velopharyngeal closure; Life Sciences; Original Research; OTORHINOLARYNGOLOGY; pharyngeal pedicled flap; predictive medicine; speech intelligibility; transplantation; pharyngeal pedicled flap; inadequate velopharyngeal closure; autologous; transplantation; predictive medicine; clinical decision-making; speech intelligibility; clinical decisionmaking
• ISSN: 1809-9777; 1809-4864; 1809-4864
• DOI: 10.1055/s-0043-1763501

Abstract
Introduction
 Velopharyngeal insufficiency (VPI) is a controversial pathology with many surgical options.
Objective
 To compare pharyngoplasty and retropharyngeal fat grafting and to build a prognostic tool to achieve perfect speech.
Methods
 Retrospective observational cohort study of 114 patients operated for VPI from 1982 to 2019 in a single tertiary center. The instrumental assessment was made using an aerophonoscope and nasofibroscopy. The variables sex, age, genetic syndromes, and type of diagnosis were analyzed with logistic regression model adjusted with propensity score. To generalize results and to build a surgical predictive tool, a marginal analysis concludes the study.
Results
 Among the patients (median [range] age 7 [4–48]), 63 (55.26%) underwent pharyngoplasty and 51 (44.74%) graft. The graft group had no complication, but it had a failure rate of 7.84%. The pharyngoplasty group had no failure, but one patient had postoperative obstructive sleep apnea. The marginal analysis demonstrated that age lower than 7 years, cleft lip and palate, absence of syndrome, and intermittent VPI were important predictive factors of good result regardless of surgical technique.
Conclusions
 Without a statistical demonstration of the superiority of pharyngoplasty over graft, and in the uncertainty of literature background, our perfect-speech patient profile represents an important tool for a postoperative forecast of results in which, like in the Master Mind game, every feature has to be considered not individually but as a pattern of characteristics whose association contributes to the outcome.