Pharyngeal Flap Versus Sphincter Pharyngoplasty for Velopharyngeal Insufficiency

This study aimed to compare outcomes of concomitant palatoplasty and sphincter pharyngoplasty with pharyngeal flap and sphincter pharyngoplasty alone for the treatment of velopharyngeal insufficiency in patients with 22q11.2 deletion syndrome. Thirty-one cases were identified for inclusion in the study. Patients were separated into 3 surgical groups: combined palatoplasty and sphincter pharyngoplasty (n = 11), pharyngeal flap (n = 7), and sphincter pharyngoplasty (n = 13). Outcome measures included perceptual speech analyses, surgical complications, and revision rates. There were no differences in preoperative speech analysis scores ( P = .31). The combined palatoplasty and sphincter pharyngoplasty procedure had similar speech outcomes compared to pharyngeal flap, and both were significantly better than sphincter pharyngoplasty alone. Complication rates ( P = .61) and the need for revision surgery ( P = .25) were similar among all 3 groups. Concomitant palatoplasty and sphincter pharyngoplasty may be an alternative treatment for velopharyngeal insufficiency in children with 22q11.2 deletion syndrome.

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Impact of Surgery for Velopharyngeal Insufficiency on Eustachian Tube Function in Children: Pharyngeal Flap Versus Sphincter Pharyngoplasty

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665621991740 ◽

2021 ◽

pp. 105566562199174

Author(s):

Colin Fuller ◽

Kesley Brown ◽

Olivia Speed ◽

James Gardner ◽

Ashlen Thomason ◽

...

Keyword(s):

Risk Factors ◽

Nasal Obstruction ◽

Eustachian Tube ◽

Velopharyngeal Insufficiency ◽

Deletion Syndrome ◽

Younger Age ◽

Obstructive Sleep ◽

Significant Difference ◽

Pharyngeal Flap ◽

Sphincter Pharyngoplasty

Objective: Velopharyngeal insufficiency (VPI) is a common speech disorder in patients with a history of cleft palate (CP) or 22q11.2 deletion syndrome. Pharyngeal flap (PF) and sphincter pharyngoplasty (SP) are 2 common surgeries to treat this disorder by decreasing unwanted nasal air emission and hypernasal resonance. Because Eustachian tube dysfunction (ETD) in patients with CP may be more frequent after surgery for VPI, we examined whether ETD was associated with either type of surgery. Design: Retrospective cohort study. Setting: Children’s hospital-based tertiary referral center. Patients: A total of 225 children with VPI who underwent primary PF (201) or SP (24) between 2006 and 2017. Outcome measures: We examined differences in risk of ETD according to both surgical groups and proxies for postoperative nasal obstruction. These proxies included postoperative resonance measures and development of obstructive sleep apnea (OSA). Results: Both surgical groups had similar preoperative measures, except the PF group had higher hypernasality by PSA. Postoperatively, the PF group demonstrated lower hypernasal resonance by nasometry and PSA. There were no differences between PF and SP groups with regard to ETD. Proxies for postoperative nasal obstruction also were not predictive of postoperative ETD. Degree of CP and younger age were found to be risk factors for ETD. Conclusion: There was no significant difference in the effects of PF and SP on ETD in this study. Neither lower hypernasality nor incidence of OSA had any impact on ETD. Degree of CP and younger age were the only significant risk factors for ETD that this study identified.

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Pharyngeal flap versus sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency: A meta-analysis

Yearbook of Plastic and Aesthetic Surgery ◽

10.1016/j.yprs.2012.07.025 ◽

2013 ◽

Vol 2013 ◽

pp. 7

Author(s):

S.H. Miller

Keyword(s):

Meta Analysis ◽

Velopharyngeal Insufficiency ◽

Pharyngeal Flap ◽

Sphincter Pharyngoplasty

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Posterior Pharyngeal Flap and Sphincter Pharyngoplasty: The State of the Art

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2000_037_0112_ppfasp_2.3.co_2 ◽

2000 ◽

Vol 37 (2) ◽

pp. 112-122 ◽

Cited By ~ 38

Author(s):

Gerald M. Sloan

Keyword(s):

Surgical Management ◽

State Of The Art ◽

Velopharyngeal Insufficiency ◽

Flap Surgery ◽

Specific Choice ◽

Obstructive Sleep ◽

Velopharyngeal Closure ◽

Pharyngeal Flap ◽

Sphincter Pharyngoplasty ◽

The 19Th Century

Surgical management of velopharyngeal insufficiency by attachment of posterior pharyngeal flap or construction of sphincter pharyngoplasty is reviewed. Posterior pharyngeal flap surgery is well established, with a long history dating back to the 19th century. Flaps have been based superiorly, inferiorly, or laterally. There have been reports of airway obstruction and obstructive sleep apnea associated with posterior pharyngeal flap surgery. The concept of surgical creation of a dynamic sphincter pharyngoplasty to provide velopharyngeal closure was first introduced by Hynes in 1950. Hynes and others have proposed several subsequent anatomic modifications. Airway dysfunction has also been reported following sphincter pharyngoplasty, but may not be as frequent or severe as with posterior pharyngeal flap. While several studies have compared posterior pharyngeal flap and sphincter pharyngoplasty in terms of speech outcome or complications, there is not, as yet, a consensus regarding the specific choice of one versus the other for surgical management of velopharyngeal insufficiency.

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Prospective evaluation of the outcome of velopharyngeal insufficiency therapy after pharyngeal flap, a sphincter pharyngoplasty, a double Z-plasty and simultaneous Orticochea and Furlow operations

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2010.06.020 ◽

2011 ◽

Vol 64 (4) ◽

pp. 459-461 ◽

Cited By ~ 9

Author(s):

Piotr Wójcicki ◽

Karolina Wójcicka

Keyword(s):

Velopharyngeal Insufficiency ◽

Prospective Evaluation ◽

Pharyngeal Flap ◽

Sphincter Pharyngoplasty

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Surgical Treatment of Velopharyngeal Insufficiency

10.5772/intechopen.96560 ◽

2021 ◽

Author(s):

Nguyen Pham ◽

Isabella Rodoni

Keyword(s):

Surgical Treatment ◽

Soft Palate ◽

Recovery Process ◽

Assessment Methods ◽

Velopharyngeal Insufficiency ◽

Patient Assessment ◽

Pharyngeal Flap ◽

Sphincter Pharyngoplasty ◽

Nasal Emission ◽

Nasal Regurgitation

Velopharyngeal insufficiency (VPI) is a condition where the soft palate and posterior oropharynx fail to close adequately, leading to complications such as abnormal speech, nasal regurgitation and nasal emission. Although there exist many approaches to treating VPI depending on the shape and severity of the insufficiency, this chapter describes the three most frequently used and well-researched techniques: the Furlow Palatoplasty (double-opposing Z-palatoplasty), the creation and placement of a pharyngeal flap, and a sphincter pharyngoplasty. This chapter contains an introduction to VPI causes and treatment, a description of patient assessment methods, step-by-step instructions for the different operative procedures, and the recovery process.

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