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.

Surgical Management of Velopharyngeal Insufficiency Due to Unilateral Oropharyngeal Agenesis in a Patient With Stickler Syndrome

2020 ◽  
pp. 105566562097741
Author(s):  
Bronson Wessinger ◽  
Kyle Kimura ◽  
James Phillips ◽  
Ryan H. Belcher
Keyword(s):  
Surgical Management ◽  
Soft Palate ◽  
Surgical Correction ◽  
Velopharyngeal Insufficiency ◽  
Patient Specific ◽  
Stickler Syndrome ◽  
Pharyngeal Flap ◽  
Nasal Regurgitation

Velopharyngeal insufficiency (VPI) results from defects interfering with closure of the velopharyngeal port. It can lead to many issues ranging from nasal regurgitation to severe speech abnormalities. Treatment is tailored to patient-specific etiology and severity, often involving surgical correction. A rare, and therefore seldom, described cause of VPI is isolated unilateral agenesis of the soft palate. We describe the case of a 2-year-old patient with Stickler syndrome possessing a unique anatomic presentation of this pathology, managed successfully with a unilateral pharyngeal flap.

Pharyngeal Flap Versus Sphincter Pharyngoplasty for Velopharyngeal Insufficiency

2019 ◽  
Vol 30 (2) ◽  
pp. 554-556 ◽  
Author(s):  
Joshua D. Horton ◽  
Sharon H. Gnagi ◽  
Carlyn M. Atwood ◽  
Shaun A. Nguyen ◽  
David R. White
Keyword(s):  
Velopharyngeal Insufficiency ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty

Assessment of the New L Pharyngeal Flap for Velopharyngeal Insufficiency

2020 ◽  
pp. 105566562095015
Author(s):  
Mohammad Waheed El-Anwar ◽  
Ezzeddin Elsheikh ◽  
Mohamed Abdelmohsen Alnemr ◽  
Amal Saed Quriba ◽  
Elham Hassan ◽  
...  
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Speech Therapy ◽  
Velopharyngeal Insufficiency ◽  
Valve Closure ◽  
Speech Evaluation ◽  
Obstructive Sleep ◽  
Horizontal Part ◽  
Pharyngeal Flap ◽  
Speech Assessment

Objective: To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI). Methods: This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation. Results: Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported. Conclusion: The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication.

Surgical Outcomes for the Treatment of Velopharyngeal Insufficiency in 22q11.2 Deletion Syndrome

2019 ◽  
Vol 161 (2) ◽  
pp. 348-351 ◽  
Author(s):  
Lauren A. Bohm ◽  
Jessa E. Miller ◽  
Noëlle Morrell ◽  
James D. Sidman ◽  
Brianne B. Roby
Keyword(s):  
Revision Surgery ◽  
22Q11.2 Deletion Syndrome ◽  
Speech Analysis ◽  
Velopharyngeal Insufficiency ◽  
Deletion Syndrome ◽  
Complication Rates ◽  
22Q11.2 Deletion ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty ◽  
Better Than

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.

Longus Capitis Reconstruction of the Soft Palate

2019 ◽  
Vol 161 (3) ◽  
pp. 536-538
Author(s):  
Jennifer H. Gross ◽  
Joseph Zenga ◽  
Jeffrey D. Sharon ◽  
Ryan S. Jackson ◽  
Patrik Pipkorn
Keyword(s):  
Soft Palate ◽  
Muscle Function ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Local Flap ◽  
Velopharyngeal Insufficiency ◽  
Single Institution ◽  
Oral Diet ◽  
Transoral Resection ◽  
Nasal Regurgitation

Soft palate (SP) reconstruction remains a challenge for the head and neck reconstructive surgeon. One favorable local flap option is the longus capitis muscle (LCM), a deep neck flexor with redundant muscle function, appropriate bulk, and a relatively straightforward surgical harvest. A retrospective review of 3 patients with T2 to T4 tonsil squamous cell carcinoma requiring SP resection and LCM reconstruction at a single institution was performed. Three patients underwent primary transoral resection, all resulting in at least 50% full-thickness SP defects. Reconstruction comprised a superiorly based LCM local flap. Patients underwent adjuvant (chemo)radiation therapy as indicated. Within 3 to 8 months, each patient was tolerating a full oral diet with no dysphagia, nasal regurgitation, or velopharyngeal insufficiency. For select patients with SP defects, a superiorly based LCM flap may provide a functionally acceptable reconstruction with minimal donor site morbidity.

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.

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.

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.

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