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

2000 ◽  
Vol 37 (2) ◽  
pp. 112-122 ◽  
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.

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

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.

Obstructive Sleep Apnea Secondary to Surgery for Velopharyngeal Insufficiency

1993 ◽  
Vol 30 (4) ◽  
pp. 387-390 ◽  
Author(s):  
Antonio Ysunza ◽  
Manuel Garcia-Velasco ◽  
Miguel Garcia-Garcia ◽  
Reyes Haro ◽  
Matilde Valencia
Keyword(s):  
Obstructive Sleep Apnea ◽  
Surgical Treatment ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Velopharyngeal Insufficiency ◽  
Flap Surgery ◽  
Obstructive Sleep ◽  
Pharyngeal Flap ◽  
Apnea Syndrome

The files of 585 patients who had had pharyngeal flap surgery for the correction of velopharyngeal insufficiency were reviewed. Eighteen patients, ranging in age from 6 to 16 years, showed clinical symptoms of obstructive sleep apnea syndrome. All of these cases had a Polysomnographic evaluation and videonasopharyngoscopy. Fifteen cases met the criteria for the diagnosis of obstructive sleep apnea syndrome and eventually underwent surgical treatment. A modified uvulopalatopharyngoplasty was done in 14 of the 15 cases. One patient had a prominent uvula flipping into the port of a Jackson's type pharyngoplasty, so a partial resection of the uvula was performed. Surgical treatment was successful in 14 of 15 cases, including the case with the partial uvular resection. In one case, severe sleep apnea persisted after surgery and a complete section of the flap was performed to correct the obstruction. Sizeable tonsils were found in 13 out of 15 cases, whereas flap width appeared unrelated to obstruction. Preoperative assessment of tonsillar tissue is of vital importance before pharyngeal flap surgery.

Obstructive Sleep Apnea Secondary to Pharyngeal Narrowing From Horizontal Donor Site Closure During Posterior Pharyngeal Flap Surgery

2020 ◽  
Vol 57 (9) ◽  
pp. 1140-1145
Author(s):  
Shamit S. Prabhu ◽  
Eleanor P. Kiell ◽  
Lisa R. David ◽  
Christopher Michael Runyan
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Surgical Intervention ◽  
Clinical Course ◽  
Donor Site ◽  
Postoperative Recovery ◽  
Velopharyngeal Insufficiency ◽  
Flap Surgery ◽  
Obstructive Sleep ◽  
Pharyngeal Flap

The posterior pharyngeal flap is frequently the surgical intervention of choice for the correction of velopharyngeal insufficiency. Our patient initially presented for a superiorly based, posterior pharyngeal flap to correct for velopharyngeal insufficiency. However, the postoperative recovery was complicated by severe obstructive sleep apnea, which warranted division and subsequent takedown of the flap. Despite flap takedown, our patient’s obstructive sleep apnea persisted. The patient’s clinical course suggests that donor site closure, and not the actual pharyngeal flap, caused the persistent obstructive sleep apnea.

Obstructive Sleep Apnea following Pharyngeal Flap Surgery for Velopharyngeal Insufficiency: A Prospective Polysomnographic and Aerodynamic Study in Middle-Aged Adults

2016 ◽  
Vol 53 (3) ◽  
pp. 53-59 ◽  
Author(s):  
Letícia Dominguez Campos ◽  
Ivy Kiemle Trindade-Suedam ◽  
Ana Claudia Martins Sampaio-Teixeira ◽  
Renata Paciello Yamashita ◽  
José Roberto Pereira Lauris ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Velopharyngeal Insufficiency ◽  
Flap Surgery ◽  
Middle Aged ◽  
Obstructive Sleep ◽  
Pharyngeal Flap ◽  
Middle Aged Adults

scholarly journals Surgical outcome of pharyngeal flap surgery and intravelar veloplasty on the velopharyngeal function

CoDAS ◽  
2013 ◽  
Vol 25 (5) ◽  
pp. 451-455 ◽  
Author(s):  
Daniela Aparecida Barbosa ◽  
Rafaeli Higa Scarmagnani ◽  
Ana Paula Fukushiro ◽  
Inge Elly Kiemle Trindade ◽  
Renata Paciello Yamashita
Keyword(s):  
Surgical Treatment ◽  
Surgical Outcome ◽  
Velopharyngeal Insufficiency ◽  
Cutoff Score ◽  
Flap Surgery ◽  
Orifice Area ◽  
Velopharyngeal Closure ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function ◽  
Intravelar Veloplasty

PURPOSE: To investigate the postoperative outcomes of pharyngeal flap surgery (PF) and secondary palatoplasty with intravelar veloplasty (IV) in the velopharyngeal insufficiency management regarding nasalance scores and velopharyngeal area. METHODS: Seventy-eight patients with cleft palate±lips submitted to surgical treatment for velopharyngeal insufficiency, for 14 months on an average, were evaluated: 40 with PF and 38 with IV, of both genders, aged between 6 and 52 years old. Hypernasality was estimated by means of nasalance scores obtained by nasometry with a cutoff score of 27%. The measurement of velopharyngeal orifice area was provided by the pressure-flow technique and velopharyngeal closure was classified as: adequate (0.000-0.049 cm2), adequate/borderline (0.050-0.099 cm2), borderline/inadequate (0.100-0.199 cm2), and inadequate (≥0.200 cm2). RESULTS: Absence of hypernasality was observed in 70% of the cases and adequate velopharyngeal closure was observed in 80% of the cases, in the PF group. In the IV group, absence of hypernasality was observed in 34% and adequate velopharyngeal closure was observed in 50% of the patients. Statistically significant differences were obtained between the two techniques for both evaluations. CONCLUSION: PF was more efficient than the secondary palatoplasty with IV to reduce hypernasality and get adequate velopharyngeal closure.

Incidence and Severity of Obstructive Sleep Apnea following Pharyngeal Flap Surgery in Patients with Cleft Palate

2002 ◽  
Vol 39 (3) ◽  
pp. 312-316 ◽  
Author(s):  
Yu-Fang Liao ◽  
Ming-Lung Chuang ◽  
Philip K.T. Chen ◽  
Ning-Hung Chen ◽  
Claudia Yun ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Flap Surgery ◽  
Adult Group ◽  
Child Group ◽  
Obstructive Sleep ◽  
Pharyngeal Flap ◽  
Respiratory Disturbance ◽  
Different Levels

Objective: To investigate the incidence and severity of obstructive sleep apnea (OSA) associated with pharyngeal flap surgery in patients with cleft palate at least 6 months postoperatively and to determine whether age or the flap width had an effect on them. The hypothesis tested in this study was that the severity of OSA associated with pharyngeal flap surgery is greater in children than in adults. Subjects: Ten adults, six men and four women, with a mean age of 28.0 years at pharyngeal flap (adult group). Twenty-eight children, 13 boys and 15 girls, with a mean age of 6.3 years at pharyngeal flap (child group). Design: A prospective analysis. Main Outcome Measures: An overnight polysomnographic study was used to determine the incidence and severity of OSA 6 months after pharyngeal flap. Results: The incidence of OSA following pharyngeal flap was high but not significantly different between these two groups (90% in adults and 93% in children, p = 1.000). When OSA was stratified into different levels of severity according to the values of respiratory disturbance index, there were noticeable differences between these two groups (p = .022). In the adult group, eight patients (89%) had mild OSA and 1 patient (11%) had moderate to severe OSA. In the child group, 11 patients (42%) were found to have mild OSA, and 15 patients (58%) had moderate to severe OSA. No relation was found between the flap width and the incidence (p = .435 in adults and .640 in children) or the severity (p = .325 in adults and .310 in children) of OSA in each group. Conclusions: Six months following pharyngeal flap surgery, more than 90% of the patients with cleft palate still had OSA. The severity of OSA associated with pharyngeal flap surgery tended to be greater in children than in adults. The flap width was unrelated to the incidence and severity of OSA, no matter in adults or in children.

Adenoid hypertrophy causing obstructive sleep apnea in children after pharyngeal flap surgery

2019 ◽  
Vol 276 (12) ◽  
pp. 3413-3417 ◽  
Author(s):  
Mosaad Abdel-Aziz ◽  
Mahmoud El-Fouly ◽  
Essam A. A. Elmagd ◽  
Ahmed Nassar ◽  
Assem Abdel-Wahid
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Adenoid Hypertrophy ◽  
Flap Surgery ◽  
Obstructive Sleep ◽  
Pharyngeal Flap

Salvaging the Failed Pharyngoplasty: Intervention Outcome

1998 ◽  
Vol 35 (5) ◽  
pp. 447-453 ◽  
Author(s):  
Peter D. Witt ◽  
Terry Myckatyn ◽  
Jeffrey L. Marsh
Keyword(s):  
Revisional Surgery ◽  
Care Center ◽  
Surgical Revision ◽  
Flap Failure ◽  
Velopharyngeal Closure ◽  
Cause Of Failure ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty ◽  
Definition Of ◽  
Velopharyngeal Function

Objective This paper reports on the rates of failure of operations (pharyngeal flap and sphincter pharyngoplasty) performed for management of velopharyngeal dysfunction, and outcome following their revision. Design Anatomic abnormalities associated with unacceptable vocal resonance and nasal air escape following pharyngeal flap and sphincter pharyngoplasty were critiqued. The results of primary pharyngeal flap were evaluated for 65 patients, and the results of primary sphincter pharyngoplasty were evaluated for 123 patients. All patients were treated for velopharyngeal dysfunction. The definition of surgical failure was based on persistent hypernasality and/or nasal turbulence on perceptual speech evaluation, and incomplete velopharyngeal closure on instrumental evaluation, at least 3 months postoperatively. Setting All patients were evaluated and managed at the Cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital, a tertiary cleft care center. Patients, Participants All patients had failed surgical management initially, either with pharyngeal flap or sphincter pharyngoplasty, and all underwent repeat preoperative and postoperative perceptual speech evaluations; real-time lateral phonation fluoroscopy including still reference views; and flexible nasendoscopy of the velopharynx using standard speech protocols. Interventions Revisional surgery for both procedures consisted of either tightening of the sphincter pharyngoplasty or pharyngeal flap port(s) or reinsertion of the sphincter pharyngoplasty or pharyngeal flaps following dehiscence. Main outcome Measures The main outcome measure was normalcy of velopharyngeal function, i.e., elimination of perceptual hypernasality and instrumental evidence of complete velopharyngeal closure. The rates of pharyngeal flap failure and sphincter pharyngoplasty failure were determined for those patients requiring surgical revision. Results Thirteen of 65 patients (20%) who underwent primary pharyngeal flap required revisional surgery. Of these 13 patients, eight were managed successfully with a single revisional operation. The remaining five patients (38%) continued to exhibit velopharyngeal dysfunction and underwent a second revision consisting of tightening or augmentation of the lateral ports. Speech results were satisfactory in all patients so treated; however, hyponasality with no other airway morbidity occurred in all five. Twenty of 123 patients (16%) who underwent primary sphincter pharyngoplasty required surgical revision. Of these 20 patients, 17 were managed successfully. For both procedures, the principal cause of failure was partial or complete flap dehiscence. Conclusions Rates of primary pharyngeal flap failure are roughly equivalent to rates of primary sphincter pharyngoplasty failure. Pharyngeal flap and sphincter pharyngoplasty failures can be salvaged with revisional surgery, which can provide a velopharyngeal mechanism capable of complete closure. Revisional surgery is usually associated with denasal speech.

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