Dutch Workflow for Diagnosis and Treatment of Velopharyngeal Insufficiency in Patients with Cleft Palate-A Survey Study.

Abstract

ObjectiveThe aim of this study was to investigate the workflow of cleft teams in the Netherlands with regard to the diagnosis and treatment of velopharyngeal insufficiency (VPI) in patients with cleft palate (CP).DesignThis is a cross-sectional survey study.SettingMulticenter study, tertiary hospital setting.ParticipantsEar-nose-throat surgeons, plastic surgeons and speech language pathologists of the eight cleft teams in the Netherlands.InterventionsA cross-sectional online survey was sent to the participants.Main Outcome Measure(s)The survey questions covered the following topics: diagnostic tests used to assess VPI, use of classification systems and cut-off values to determine the most optimal treatment, treatment of VPI, and postoperative follow-up.ResultsThe response rate was 88% (n = 7 cleft teams). Frequently described diagnostic tests to assess VPI include perceptual speech assessment, mirror test, nasendoscopy, oral inspection, patient-reported outcome measures, nasometry, and videofluoroscopy. Most centers reported that they did not use a classification system to determine the severity of VPI. None of the centers reported to use cut-off values based on the diagnostic tests to determine optimal treatment. The reported minimum duration of speech therapy prior to surgery varied. Many different surgical techniques were reported for the treatment of VPI. Regarding postoperative follow-up, survey responses indicate agreement on the multidisciplinary approach and diagnostic tests used. The timing of the visits varied.ConclusionFurther standardization of the diagnostic process and treatment workflow of VPI in patients with CP between Dutch cleft centers is needed in order to compare outcomes of different surgical techniques and to establish a national protocol for optimal treatment.