Our unified pharyngeal flap operation

Kogo, Mikihiko; Sakai, Takayoshi; Harada, Takeshi; Nohara, Kanji; Isomura, EmikoTanaka; Seikai, Tetsuya; Otsuki, Koichi; Sugiyama, Chihiro; Nakagawa, Kiyoko; Tanaka, Susumu

doi:10.4103/jclpca.jclpca_82_17

Cited by 4 publications

(3 citation statements)

References 3 publications

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“…If VPI cannot be managed with speech therapy, a speech aid is used for closure of the nasopharynx by lifting the soft palate or filling the gap. Then, after VPI is shown to be controlled with the speech aid, pharyngeal flap surgery is performed to wean the patient off the speech aid [ 1 – 3 ]. However, it is difficult to apply this treatment in children because it causes fundamental changes to the velopharyngeal form, which may result in sleep apnea or inability to perform nasal intubation during future orthodontic surgeries [ 4 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic soft palate augmentation using injectable materials in dogs to ameliorate velopharyngeal insufficiency

et al. 2020

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Background Velopharyngeal structure augmentation methods are used as alternatives to pharyngeal flap operations. Recently, we investigated the sites of velopharyngeal structure augmentation in dogs and reported that the most effective injection location is the soft palate. However, there have been no reports regarding the optimal materials for implantation or injection. In this study, we aimed to investigate the injectable materials used in soft palate augmentation in dogs to ameliorate velopharyngeal insufficiency (VPI). Methods Endoscopic soft palate augmentation (ESPA) was performed in dogs using purified sodium hyaluronate, atelocollagen, or autogenic fat tissue. ESPA is an original technique developed by our group, and this is the first report of its performance. Moreover, we assessed the amount of nasal air leakage during inspiration at rest and during expiration under the rebreathing system at 1, 2, 3, 4, 5, and 6 months after injection of these materials. Results The amount of nasal air leakage during expiration under the rebreathing system was significantly decreased in all dogs injected with the ESPA materials, but neither apnea nor hypopnea was observed. Conclusions We investigated the optimal materials for use in ESPA, such as purified sodium hyaluronate, atelocollagen, or autogenic fat tissue. We found that all of them reduced nasal air leakage and only autogenic fat tissue showed significant histologic differences in dogs at 6 months. This technique may also be useful for the treatment of patients with VPI.

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Section: Introductionmentioning

confidence: 99%

Endoscopic soft palate augmentation using injectable materials in dogs to ameliorate velopharyngeal insufficiency

et al. 2020

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“…Some cleft palate patients exhibit VPI even after palatoplasty, thereby necessitating the use of several additional operation methods [2–3]. Traditionally, the velopharyngeal plasty using posterior pharyngeal wall flap is a standard operation method for VPI [4–6]; however, it is difficult to adapt this method for treatment in children, as it causes fundamental change to the velopharyngeal form, which may result in sleep apnea or an inability to perform nasal intubation during future orthodontic surgery [7–10].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of sites of velopharyngeal structure augmentation in dogs for improvement of velopharyngeal insufficiency

et al. 2019

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Background Velopharyngeal structure augmentation methods are used as alternatives to velopharyngeal plasty. Anatomic sites of implantation/injection vary widely due to a lack of standardized criteria. Here, we experimentally investigated optimal sites of velopharyngeal structure augmentation via saline injection in dogs as they naturally exhibit velopharyngeal insufficiency (VPI). Methods Velopharyngeal structure augmentation was performed on 10 beagles (age range: 20–24 months; weight range: 9–12 kg). Saline containing 1/80,000 epinephrine was injected intraorally in 1-mL increments into the nasal mucosa of the soft palate (n = 4), posterior pharyngeal wall (n = 3), or bilateral pharyngeal walls (n = 3) of each dog. Nasal air leakage was measured under rebreathing until velopharyngeal closure was achieved; the measurement was performed using flow meter sensors on both nasal apertures, and the oral cavity was filled with alginate impression material to prevent oral air leakage. Results Pre-injection, the dogs exhibited an average of 0.455 L/s air leakage from the nasal cavity. The dogs with saline injected into the nasal mucosa of the soft palate achieved steady augmentation, and nasal air leakage disappeared under rebreathing following 6-mL saline injection. Conversely, nasal air leakage remained in the dogs with saline injected in the posterior pharyngeal wall or bilateral pharyngeal walls. Conclusions During VPI treatment in dogs, augmentation was most effective at the nasal mucosa of the soft palate. Improvement in nasal air leakage was highly dependent on the saline injection volume. Although velopharyngeal structures vary between dogs and humans, velopharyngeal closure style is similar. Thus, our results may aid in the treatment of VPI patients.

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“…If velopharyngeal incompetence remains even after the surgery because of the lack of soft palate tissue, the contractile scar, and inadequate LVP muscle reconstruction (Ruding, 1964; Brown et al, 1983), the more appropriate velopharyngeal plasty must be performed (Kogo et al, 2017).…”

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confidence: 99%

The Behaviors of the Levator Veli Palatine Muscle Between 2 Surgical Conditions in Dog: The Comparison of Furlow and Pushback Methods

Nakagawa

Isomura

Matsukawa

et al. 2020

The Cleft Palate-Craniofacial Journal

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Objective: This study was conducted to compare the velopharyngeal function among the beagle dogs which the levator veli palatini (LVP) muscles construction has been experimentally changed. Methods: Four groups of LVP muscle reconstruction were made (normal LVP, cut LVP, end-to-end sutured LVP, and overlapped-sutured LVP at the midline). Levator veli palatini contraction was induced by electrical stimulation or a hypercapnia condition to analyze the strength of the velopharyngeal closure using balloon with a blood pressure meter, and the electromyogram in those operated beagle dogs. Results: Under a hypercapnia condition, the velopharyngeal function did not differ significantly among the 4 groups in the terms of velopharyngeal pressure. The strongest closure was shown at the overlapped sutured LVP group by electrical stimulation. Conclusion: The reconstruction of overlapped sutured LVP showed the most effective closure. This study suggested that the palatoplasty should be conducted along the overlapped LVP (like Furlow method).

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Our unified pharyngeal flap operation

Cited by 4 publications

References 3 publications

Endoscopic soft palate augmentation using injectable materials in dogs to ameliorate velopharyngeal insufficiency

Endoscopic soft palate augmentation using injectable materials in dogs to ameliorate velopharyngeal insufficiency

Evaluation of sites of velopharyngeal structure augmentation in dogs for improvement of velopharyngeal insufficiency

The Behaviors of the Levator Veli Palatine Muscle Between 2 Surgical Conditions in Dog: The Comparison of Furlow and Pushback Methods

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