Surgical Treatment of Patients with Velopharyngeal Insufficiency using Superiorly Based Pharyngeal Flap: Report of 2 Cases

2021 ◽  
Vol 24 (2) ◽  
pp. 77-83
Author(s):  
Jaeho Jang ◽  
Siyoung Kim ◽  
Sung-ho Ha ◽  
Jin-young Choi
Keyword(s):  
Surgical Treatment ◽  
Velopharyngeal Insufficiency ◽  
Pharyngeal Flap

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.

scholarly journals Surgical Treatment of Velopharyngeal Insufficiency

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.

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.

Posterior Pharyngeal Flap for Velopharyngeal Insufficiency Patients

2016 ◽  
Vol 27 (1) ◽  
pp. 204-208 ◽  
Author(s):  
Ezzeddin Elsheikh ◽  
Mohammad Waheed El-Anwar
Keyword(s):  
Velopharyngeal Insufficiency ◽  
Pharyngeal Flap

Lateral pharyngeal flap with a double pedicle for repair of unilateral velopharyngeal insufficiency

2020 ◽  
Vol 47 (2) ◽  
pp. 245-249
Author(s):  
Shun-ichi Chitose ◽  
Kiminori Sato ◽  
Mioko Fukahori ◽  
Takashi Kurita ◽  
Kiminobu Sato ◽  
...  
Keyword(s):  
Velopharyngeal Insufficiency ◽  
Pharyngeal Flap

Comparison of Obstructive Sleep Apnea Syndrome in Children with Cleft Palate following Furlow Palatoplasty or Pharyngeal Flap for Velopharyngeal Insufficiency

2004 ◽  
Vol 41 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Yu-Fang Liao ◽  
M. Samuel Noordhoff ◽  
Chiung-Shing Huang ◽  
Philip K. T. Chen ◽  
Ning-Hung Chen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Velopharyngeal Insufficiency ◽  
Obstructive Sleep ◽  
The Mean ◽  
Pharyngeal Flap ◽  
Apnea Syndrome

Objective To evaluate the incidence and severity of obstructive sleep apnea syndrome (OSAS) in patients with cleft palate having a Furlow palatoplasty or pharyngeal flap for correction of velopharyngeal insufficiency (VPI). Patients A total of 48 nonsyndromic children with repaired cleft palate with VPI were enrolled in the study. Twenty of the children had a Furlow palatoplasty (F group) and 28 children had a pharyngeal flap (P group) for correction of VPI. Interventions An overnight polysomnography evaluation was done to evaluate the incidence and severity of OSAS 6 months or more postoperatively. Main Outcome Measures Symptoms of OSAS, respiratory disturbance index (RDI), oxyhemoglobin desaturation index (DI), and sleep stages were measured. Results In the P group, the mean percentage of stage 2 sleep was lower than the F group (p < .05). The mean RDI and DI were larger in the P group, compared with the F group (p < .001). The incidence and severity of OSAS were higher in the P group, compared with the F group (p < .001 and p = 0.05, respectively). Conclusions A Furlow palatoplasty should be used in deference to a pharyngeal flap whenever possible on the basis of the preoperative evaluation of VPI because of the decreased incidence and severity of OSAS.

Prosthetic Management of Pharyngeal Flap–Related Snoring

2007 ◽  
Vol 44 (4) ◽  
pp. 418-420
Author(s):  
William N. Williams ◽  
Glenn T. Turner ◽  
Kelley Lewis ◽  
Maria Inês Pegoraro-Krook ◽  
Jeniffer C. R. Dutka-Souza
Keyword(s):  
Obstructive Sleep Apnea ◽  
Case Report ◽  
Soft Tissues ◽  
Velopharyngeal Insufficiency ◽  
Nasal Breathing ◽  
Obstructive Sleep ◽  
Removable Prosthesis ◽  
Pharyngeal Flap ◽  
Lateral Walls

Objective: The obturating pharyngeal flap used in correcting velopharyngeal insufficiency has been implicated in creating difficulty in nasal breathing for some patients and/or in causing hyponasal speech, obstructive sleep apnea, and snoring. This is a case report of an individually designed removable prosthesis that positions an acrylic tube through each port lateral to the pharyngeal flap, with the goal of preventing the collapse of the ports during sleep and the consequent snoring. Design: The acrylic tubes maintain an opening through both lateral ports preventing the soft tissues of the lateral walls from vibrating against the pharyngeal flap (causing the snoring sound) and allowing nasal breathing. Results: The acrylic tubes effectively eliminated the patient's problem of snoring. Conclusions: This case study demonstrates that snoring associated with a pharyngeal flap can be controlled prosthetically by maintaining an opening through the two lateral ports, preventing the soft tissues of the walls of the lateral ports from vibrating against the flap.

scholarly journals Successful Pharyngoplasty After Le Fort I Advancement In A Severely Neglected Cleft Lip And Palate Patient

2021 ◽  
Vol 4 (1) ◽  
pp. 24
Author(s):  
Timotius Hansen Arista ◽  
Magda Rosalina Hutagalung
Keyword(s):  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Velopharyngeal Insufficiency ◽  
Age At Surgery ◽  
Orthognatic Surgery ◽  
Speech Therapist ◽  
Pharyngeal Flap ◽  
Operative Assessment ◽  
Type 3

Background: When indicated, velopharyngeal insufficiency (VPI) is treated with pharyngoplasty with consideration of patient’s age. Several studies have evaluated the relationship between age at surgery and speech outcome. The best results regarding reduction of open nasality were obtained when surgeries were performed around age of 5 to 6 years and operative complications were also less frequent in the younger age group than in older patients. Pre-operative assessment such as nasopharyngoscopy and/or videofluoroscopy gives surgeons a chance to estimate flap dimension to correct the defect causing the VPI. Moreover, velopharyngoplasty proceeded with speech therapy yields better recovery.Case History : A seriously neglected case of cleft lip and palate was reported. A 24 years old female underwent two palatorrhaphy at age 13 and 14 years old, which were far beyond the recommended age of 10 – 12 months. The resulting hypernasality was further worsened by absence of speech therapy which should have been followed from age 1 – 4 years old. On presentation, this patient requested to have immediate orthognatic surgery to repair his severe type 3 facial profile and malocclusion, a procedure which he underwent worsening the VPI. We decided to surgically correct the VPI. Nasoendoscopic assessment revealed he had an antero-posterior velopharyngeal closure problem which indicated a pharyngoplasty using a superiorlybased pharyngeal flap. Three months post-operatively his speech was re-evaluated by a speech therapist and nasoendoscopically. Despite imperfectness, significant improvement was achieved.Conclusion : Pharyngoplasty could still be reliable to a certain extent as a correction treatment of VPI in a seriously neglected case. A posterior pharyngeal flap helped this patient to recover significant speech capacity.

Furlow Palatoplasty to Restore Velopharyngeal Competence following Tonsillectomy Avulsion of a Pharyngeal Flap

2001 ◽  
Vol 38 (1) ◽  
pp. 84-88
Author(s):  
Arun K. Gosain ◽  
Daniel Remmler
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Salvage Procedure ◽  
Flap Surgery ◽  
Routine Procedure ◽  
Port Closure ◽  
Mechanical Interference ◽  
Submucous Cleft Palate ◽  
Previously Treated ◽  
Pharyngeal Flap

Objective We report the successful use of a Furlow palatoplasty to salvage velopharyngeal competence following iatrogenic avulsion of a pharyngeal flap that had been previously established to treat velopharyngeal insufficiency associated with a submucous cleft palate. Intervention A tonsillectomy, conducted by a surgeon unaffiliated with a cleft palate team, was used to remove enlarged tonsils that had developed after pharyngeal flap surgery and extended into the lateral ports causing nasal obstruction and hypernasality because of mechanical interference with port closure. A posttonsillectomy evaluation revealed avulsion of the pharyngeal flap, which was successfully treated using a Furlow palatoplasty. Conclusions To our knowledge, this is the first report of iatrogenic avulsion of a pharyngeal flap caused by tonsillectomy. Based on a review of the literature and this case experience, we would conclude that tonsillectomy should not be regarded as a routine procedure in patients previously treated with a pharyngeal flap. If required, it should be performed by a skilled otolaryngologist, preferably one affiliated with a multidisciplinary cleft palate team who is familiar with pharyngoplasty surgery. Finally, our experience would suggest that the Furlow palatoplasty is sufficiently robust to be used as a secondary salvage procedure to restore velopharyngeal sufficiency following iatrogenic avulsion of a pharyngeal flap.

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