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

Chiara Suzzi; Gianfranco Di Gennaro; Hélène Baylon; Guillaume Captier

doi:10.1055/s-0043-1763501

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

Int Arch Otorhinolaryngol. 2023 Mar 29;27(2):e351-e361. doi: 10.1055/s-0043-1763501. eCollection 2023 Apr.

Authors

Chiara Suzzi^{1

2}, Gianfranco Di Gennaro³, Hélène Baylon⁴, Guillaume Captier^{1

4}

Affiliations

¹ Research Team ICAR, LIMM, CNRS, Montpellier University, Montpellier, France.
² Subintensive Care Unit, Montecatone Rehabilitation Institute, Imola (BO), Italy.
³ Department of Health Sciences, University of Catanzaro "Magna Græcia," Catanzaro, Italy.
⁴ Pediatric Orthopedic and Plastic Surgery, University Hospital of Montpellier, Montpellier University, Montpellier, France.

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.

Keywords: autologous; clinical decision-making; inadequate velopharyngeal closure; pharyngeal pedicled flap; predictive medicine; speech intelligibility; transplantation.

Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).