{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T06:15:47Z","timestamp":1790057747994,"version":"4.0.1"},"reference-count":38,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the most effective surgical technique for treating velopharyngeal insufficiency (VPI) following primary cleft palate repair, based on improvement in hypernasality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis of published studies evaluating surgical outcomes for secondary palatoplasty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Isfahan Cleft Care Team, Isfahan, Iran, conducted between 2024 and 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Participants<\/jats:title>\n                    <jats:p>A total of 1774 patients with VPI across 31 studies were included. Syndromic patients and studies lacking original data were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Five surgical techniques were evaluated: pharyngeal flap, sphincter pharyngoplasty, Furlow Z-plasty, buccal flap, and buccinator flap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure(s)<\/jats:title>\n                    <jats:p>Improvement in hypernasality, defined as any reduction in severity assessed by speech pathologists using perceptual and instrumental tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Furlow palatoplasty demonstrated the highest average improvement rate (85.06%), followed by pharyngeal flap (84.50%), sphincter pharyngoplasty (83.04%), buccinator flap (77.61%), and buccal flap (59.69%). Heterogeneity was high across most surgical groups (\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      up to 100%), indicating variability in study design and patient characteristics. Complication rates and quality of life outcomes varied, with pharyngeal flap associated with higher rates of obstructive sleep apnea in some studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Furlow palatoplasty and pharyngeal flap are the most effective surgical techniques for improving hypernasality in VPI patients post-primary cleft palate repair. However, significant heterogeneity and variable complication profiles underscore the need for individualized surgical planning and further prospective research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656251413361","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T14:08:25Z","timestamp":1770646105000},"page":"3346-3356","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The Most Efficient Surgical Technique to Treat Velopharyngeal Insufficiency After Primary Cleft Palate Repair: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3427-9524","authenticated-orcid":false,"given":"Amirhossein","family":"Fasahat","sequence":"first","affiliation":[{"name":"Isfahan University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Omid","sequence":"additional","affiliation":[{"name":"Isfahan University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Khanlar","sequence":"additional","affiliation":[{"name":"Isfahan University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammadreza","family":"Maracy","sequence":"additional","affiliation":[{"name":"School of Public Health, Isfahan University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59111932"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2017.0639"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000006681"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22456"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000007343"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211035914"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0b013e31820f3691"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2015.07.044"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2020.109977"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000100806.45065.35"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-59980300709-5"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2017.06.029"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665618756072"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2015.07.006"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200211000-00003"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2004.06.010"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00238-008-0254-y"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2019.11.023"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000744"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1597\/03-148.1"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656241264644"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211035914"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004255"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004696"},{"issue":"11","key":"e_1_3_2_26_2","article-title":"Comparative effectiveness of secondary Furlow and buccal myomucosal flap lengthening to treat velopharyngeal insufficiency","volume":"11","author":"Sitzman TJ","year":"2023","unstructured":"Sitzman TJ, Perry JL, Snodgrass TD, Temkit MH, Singh DJ, Williams JL. 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