Modified Superior-Based Pharyngeal Flap Is Effective in Treatment of Velopharyngeal Insufficiency Regardless of the Preoperative Closure Pattern

Abstract

Velopharyngeal insufficiency (VPI) is certainly one of the most important problems confronted after cleft palate repairs. In this study, it was aimed to evaluate the preoperative and postoperative speaking results of patients who underwent modified superior-based pharyngeal flap. Sixty-six children who underwent modified superiorly based pharyngeal flap for treatment of VPI between 2005 and 2013 were retrospectively reviewed. The study population was evaluated in 2 distinctive groups depending on their preoperative velopharyngeal closure pattern as: coronal closure pattern or noncoronal closure patterns (ie, circular, sagittal with or without the presence of a Passavant ridge). The speech outcome of the patients was evaluated using the objective assessment tools of nasopharyngoscopy and nasometer. Coronal closure pattern was determined in 24 patients (36.4%) and noncoronal closure pattern in 42 patients (63.6%). The mean follow-up period was 14.67 ± 3.90 and 13.74 ± 3.53 months in the coronal and noncoronal groups, respectively. The results demonstrated that the postoperative nasalance scores of all syllables except (m) and (n) were found to be significantly lower compared to those of the preoperative period (P < 0.001). However, no significant difference between the preoperative and postoperative results was observed in means of closure pattern. The surgical approach of modified superior-based pharyngeal flap for treatment of VPI appears to be effective regardless of the preoperatively determined closure pattern.

Velar Closing Ratio As a Predictor for the Verlopharyngeal Function After Double Opposing Z-Plasty for Postpalatoplasty Velopharyngeal Insufficiency in Patients With Cleft Palate

“…However, in this study, we did not find any association between closure pattern and successful outcome. The similar reports presented by Ekin et al (2017) indicated no significant difference between the preoperative and postoperative results in terms of the mean closure pattern after the surgical approach using a modified superior-based pharyngeal flap for VPI in 66 children. Finally, there were no patients with sagittal closure pattern in this study.…”

A secção cirúrgica do retalho faríngeo pode comprometer a ressonância de fala de indivíduos com fissura labiopalatina?

“…Among the surgical techniques described in the literature for the treatment of velopharyngeal dysfunction, pharyngeal flap surgery with superior pedicle still presents high success rates concerning the elimination of speech symptoms (7,(21)(22)(23)(24) .…”

Characteristics and surgical outcomes of cleft palate in kabuki syndrome: a case series of 11 patients

“…A flexible fiberoptic endoscope was inserted for evaluation of velopharyngeal motility and visualization of the anatomy under various conditions and phonations. VPI was evaluated by closure of the velopharyngeal port during phonation [ 15 ]. To determine the surgical plan preoperatively, or to evaluate postoperative outcomes, the size of the central gap was measured with the lateral pharyngeal walls maximally contracted to the velopharyngeal port.…”

“…LITE is a modified two-flap palatoplasty that limits the incision at the anterior hard palate and elevates the movable palatal flap with thorough dissection over the entire palate [13]. DOZ or LITE was considered to be ineffective when the results of speech evaluation and nasopharyngoscopy showed that the palatal muscle was incompetent, and PPF was performed to create an anatomical barrier between the oral cavity and the nasal cavity to reduce nasal emission [15]. The PPF procedure involves elevation of a superior-based myomucosal flap and insertion into the soft palate to create a static sling and overcome the VPI.…”