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Diagnosing subtle palatal anomalies: Validation of video-analysis and assessment protocol for diagnosing occult submucous cleft palate.

Abstract Submucous cleft palate (SMCP) classically involves bifid uvula, zona pellucida, and notched hard palate. However, patients may present with more subtle anatomic abnormalities. The ability to detect these abnormalities is important for surgeons managing velopharyngeal dysfunction (VPD) or considering adenoidectomy.
PMID
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Authors

Mayor MeshTerms
Keywords

Occult submucous cleft palate

Palate activation

Submucous cleft palate

Velopharyngeal dysfunction

Velopharyngeal insufficiency

Video analysis

Journal Title international journal of pediatric otorhinolaryngology
Publication Year Start




PMID- 28802381
OWN - NLM
STAT- MEDLINE
DA  - 20170813
DCOM- 20170907
LR  - 20170907
IS  - 1872-8464 (Electronic)
IS  - 0165-5876 (Linking)
VI  - 100
DP  - 2017 Sep
TI  - Diagnosing subtle palatal anomalies: Validation of video-analysis and assessment 
      protocol for diagnosing occult submucous cleft palate.
PG  - 242-246
LID - S0165-5876(17)30257-4 [pii]
LID - 10.1016/j.ijporl.2017.06.009 [doi]
AB  - INTRODUCTION: Submucous cleft palate (SMCP) classically involves bifid uvula,
      zona pellucida, and notched hard palate. However, patients may present with more 
      subtle anatomic abnormalities. The ability to detect these abnormalities is
      important for surgeons managing velopharyngeal dysfunction (VPD) or considering
      adenoidectomy. OBJECTIVES: Validate an assessment protocol for diagnosis of
      occult submucous cleft palate (OSMCP) and identify physical examination features 
      present in patients with OSMCP in the relaxed and activated palate positions.
      METHODS: Study participants included patients referred to a pediatric VPD clinic 
      with concern for hypernasality or SMCP. Using an appropriately encrypted iPod
      touch, transoral video was obtained for each patient with the palate in the
      relaxed and activated positions. The videos were reviewed by two
      otolaryngologists in normal speed and slow-motion, as needed, and a questionnaire
      was completed by each reviewer pertaining to the anatomy and function of the
      palate. RESULTS: 47 patients, with an average age of 4.6 years, were included in 
      the study over a one-year period. Four videos were unusable due to incomplete
      view of the palate. The most common palatal abnormality noted was OSMCP,
      diagnosed by each reviewer in 26/43 and 30/43 patients respectively. Using the
      assessment protocol, agreement on palatal diagnosis was 83.7% (kappa = 0.68),
      indicating substantial agreement, with the most prevalent anatomic features being
      vaulted palate elevation (96%) and visible notching of hard palate (75%).
      CONCLUSION: The diagnosis of subtle palatal anomalies is difficult and can be
      subjective. Using the proposed video-analysis method and assessment protocol may 
      improve reliability of diagnosis of OSMCP.
CI  - Copyright (c) 2017 Elsevier B.V. All rights reserved.
FAU - Rourke, Ryan
AU  - Rourke R
AD  - Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, 
      4401 Penn Avenue, 7th Floor Faculty Pavilion, Pittsburgh, PA 15224, USA.
      Electronic address: [email protected]
FAU - Weinberg, Seth M
AU  - Weinberg SM
AD  - School of Dental Medicine, University of Pittsburgh, 3501 Terrace Street,
      Pittsburgh, PA 15213, USA. Electronic address: [email protected]
FAU - Marazita, Mary L
AU  - Marazita ML
AD  - School of Dental Medicine, University of Pittsburgh, 3501 Terrace Street,
      Pittsburgh, PA 15213, USA. Electronic address: [email protected]
FAU - Jabbour, Noel
AU  - Jabbour N
AD  - Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, 
      4401 Penn Avenue, 7th Floor Faculty Pavilion, Pittsburgh, PA 15224, USA.
      Electronic address: [email protected]
LA  - eng
PT  - Journal Article
PT  - Validation Studies
DEP - 20170708
PL  - Ireland
TA  - Int J Pediatr Otorhinolaryngol
JT  - International journal of pediatric otorhinolaryngology
JID - 8003603
SB  - IM
MH  - Child
MH  - Cleft Palate/*diagnosis/surgery
MH  - Female
MH  - Humans
MH  - Male
MH  - Palate, Hard/*abnormalities
MH  - Reproducibility of Results
MH  - Velopharyngeal Insufficiency/*diagnosis/surgery
MH  - Video Recording
OTO - NOTNLM
OT  - Occult submucous cleft palate
OT  - Palate activation
OT  - Submucous cleft palate
OT  - Velopharyngeal dysfunction
OT  - Velopharyngeal insufficiency
OT  - Video analysis
EDAT- 2017/08/15 06:00
MHDA- 2017/09/08 06:00
CRDT- 2017/08/14 06:00
PHST- 2017/02/27 [received]
PHST- 2017/06/02 [revised]
PHST- 2017/06/10 [accepted]
AID - S0165-5876(17)30257-4 [pii]
AID - 10.1016/j.ijporl.2017.06.009 [doi]
PST - ppublish
SO  - Int J Pediatr Otorhinolaryngol. 2017 Sep;100:242-246. doi:
      10.1016/j.ijporl.2017.06.009. Epub 2017 Jul 8.