Pharyngeal Flap and Sphincterplasty for Velopharyngeal Insufficiency Have Equal Outcome at 1 Year Postoperatively: Results of a Randomized Trial

Åbyholm, Frank; DʼAntonio, Linda L.; Sl, Davidson; Kjøll, Lillian; Saeed, Muhammad; Shaw, William C.; Sloan, Gerald M.; Whitby, David; Worhington, H; Wyatt, Rosemary

doi:10.1597/03-148.1

Cited by 108 publications

(61 citation statements)

References 37 publications

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“…No previous study has shown an improvement in hypernasality over time because few groups have presented results with multiple postoperative time points. The VPI Surgical Trial Group compared sphincter pharyngoplasty and pharyngeal flap (10). Using the end point of hypernasal resonance, the sphincter pharyngoplasty group was found to be inferior at the threemonth time point (P<0.01) but equivalent at one year.…”

Section: Discussionmentioning

confidence: 99%

Contractility of sphincter pharyngoplasty: Relevance to speech outcomes

Hubbard

Rice

Muzaffar

2013

Canadian Journal of Plastic Surgery

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Background Sphincter pharyngoplasty has demonstrated time-tested results as a surgical treatment for velopharyngeal incompetence (VPI). However, controversy surrounding the contractility of the transposed muscles persists. Completely unaddressed in the literature is whether the dynamism of the sphincter affects speech outcomes. Objective To determine whether active sphincter contraction following sphincter pharyngoplasty influences velopharyngeal closure, nasal emission and hypernasality. Methods A prospective analysis of patients with VPI after cleft palate repair undergoing sphincter pharyngoplasty by a single surgeon was performed. Video nasendoscopy and videofluoroscopy were performed preoperatively and postoperatively at three and 12 months. Eighteen consecutive patients with cleft palate with or without cleft lip and VPI were reviewed. The average age of the patients at initial evaluation was 7.3 years, with a range of three to 19 years. Dynamicity of sphincter pharyngoplasty, velar closing ratio (VCR), and lateral wall movement (LWM) were assessed by nasendoscopy and videofluoroscopy. Nasal emission and hypernasality were assessed by perceptual speech examination. Results For longitudinal comparison, three groups were created: dynamic at three and 12 months (n=12); adynamic at three months and dynamic at 12 months (n=4); and adynamic at three and 12 months (n=2). Perceived hypernasality scores significantly improved at three months (P=0.0001) and showed continued improvement at 12 months (P=0.03), despite no change in VCR and LWM from three to 12 months. There were no significant differences among the three groups at any time point. Discussion Sphincter pharyngoplasty effectively treats VPI in appropriately selected patients. Although the VCR and LWM remained stable between three months and one year, four of six adynamic sphincters became dynamic. Considering all patients, hypernasality showed continued improvement from three months to one year. Conclusions There were no differences between dynamic and adynamic sphincters in terms of speech outcomes or the mechanical properties of velopharyngeal closure.

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Section: Discussionmentioning

confidence: 99%

Contractility of sphincter pharyngoplasty: Relevance to speech outcomes

Hubbard

Rice

Muzaffar

2013

Canadian Journal of Plastic Surgery

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“…A large group of researchers compared the speech results obtained before and after sphincteroplasty in 45 individuals, and the pharyngeal flap in 52 individuals, using perceptual, nasometric and nasoendoscopy evaluations. The authors verified that both surgical techniques were equally effective in reducing nasalance scores and eliminating hypernasality, which occurred in 76% of the cases submitted to sphincteroplasty and 81% of the pharyngeal flap cases 21 . Likewise, other researchers did not verify significant differences between one group of 26 patients submitted constituting a bridge between both, delimiting two lateral orifices.…”

Section: Introductionmentioning

confidence: 83%

“…Therefore, the pharyngeal flap was more efficient than intravelar veloplasty for correcting hypernasality and for adequate velopharyngeal closure 26 . Sphincteroplasty surgical results have also been frequently compared to other surgical techniques, in isolation or combined, aimed at establishing the most effective technique for correcting velopharyngeal insufficiency 12, 21,28 . A large group of researchers compared the speech results obtained before and after sphincteroplasty in 45 individuals, and the pharyngeal flap in 52 individuals, using perceptual, nasometric and nasoendoscopy evaluations.…”

Section: Introductionmentioning

confidence: 99%

Comparação entre cirurgia do retalho faríngeo e esfincteroplastia: análise nasométrica e aerodinâmica

et al. 2015

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OBJETIVO: comparar o efeito do retalho faríngeo e da esfincteroplastia sobre a hipernasalidade da fala e o fechamento velofaríngeo no tratamento de indivíduos com insuficiência velofaríngea residual, por meio de avaliação instrumental. MÉTODOS: foram avaliados 30 pacientes, com fissura de palato±lábio reparada, submetidos à correção cirúrgica da insuficiência velofaríngea (15 com retalho faríngeo e 15 com esfincteroplastia), avaliados antes e, no mínimo, 1 ano após a cirurgia. A hipernasalidade foi estimada a partir dos escores de nasalância (correlato físico da nasalidade) obtidos por meio da nasometria, durante a leitura de 5 sentenças contendo, exclusivamente, sons orais, considerando como limite de normalidade o escore de 27%. O fechamento velofaríngeo foi aferido a partir da medida da área velofaríngea obtida por meio da técnica fluxo-pressão e foi classificado em: 0-4,9mm2=adequado; 5-19,9mm2=marginal e, >20mm2=inadequado. Diferenças entre as duas técnicas foram consideradas estatisticamente significantes ao nível de 5%. RESULTADOS: antes da cirurgia, os valores médios de nasalância foram de 43±8,4% e 45±14,2% e de área velofaríngea foram 51±35,4mm2, e 69±29,2mm2, para os grupos retalho faríngeo e esfincteroplastia, respectivamente. Após a cirurgia, os valores médios de nasalância reduziram para 27±10,1% e 31±14,2% e de área velofaríngea para 3,6±5,5mm2 e 24±32,7mm2 para os grupos retalho faríngeo e esfincteroplastia, respectivamente. A redução dos valores de nasalância e área velofaríngea foi estatisticamente significante nos dois grupos. CONCLUSÃO: estes resultados sugerem que o retalho faríngeo foi mais eficiente do que a esfincteroplastia na eliminação da hipernasalidade e adequação do fechamento velofaríngeo nos pacientes estudados.

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“…In group IV+PF, oral respiration was observed in 61% (14), snoring in 69% (16) and sleep respiratory disorder in 9% (2).…”

Section: Investigation Of Respiratory Symptomsmentioning

confidence: 99%

“…During speech, the orifices should close by the action of lateral pharyngeal walls, to avoid nasal air escape and hypernasality, thereby directing the airflow to the oral cavity (7,9,12) . There is consensus in the literature about the high success rate of pharyngeal flap surgery to reduce or eliminate the speech symptoms caused by VPI (12,13,14) . However, there is concern among clinicians and investigators in this field about surgeries that change the anatomy of the velopharyngeal region and alter the nasopharyngeal permeability, such as the pharyngeal flap (9,13,15) .…”

Section: Introductionmentioning

confidence: 99%

Comparação entre duas abordagens diferentes de tratamento cirúrgico da insuficiência velofaríngea

Yamashita

Rissato

Scarmagnani

et al. 2017

Audiol., Commun. Res.

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Introduction: Secondary palatoplasty with intravelar veloplasty (IV) may be performed before pharyngeal flap (PF) for surgical treatment of velopharyngeal insufficiency in individuals with cleft palate. This surgical approach aims to improve the velopharyngeal conditions, thus avoiding indication of a large pharyngeal flap and its undesirable effects on respiration. Purpose: To investigate the effects of pharyngeal flap performed after intravelar veloplasty for the treatment of velopharyngeal insufficiency on nasality and respiration. Methods: Analysis of postoperative outcomes of speech nasality and respiration in 50 individuals with repaired cleft palate and velopharyngeal insufficiency, being 23 submitted to pharyngeal flap after intravelar veloplasty (Group IV+PF) and 27 submitted only to pharyngeal flap (Group PF). Nasality was determined by nasometry, and the effect of surgery on respiration was assessed by measuring the minimum nasopharyngeal transverse section area, obtained by the pressure-flow technique and investigation of respiratory complaints, using a specific questionnaire. Statistical comparison between groups was performed by the Mann-Whitney test and Student t test, at a significance level of p<0.05. Results: There was no difference between groups for the outcomes of nasality, measurement of nasopharyngeal area and investigation of respiratory complaints. Conclusion: Both approaches for surgical treatment of velopharyngeal insufficiency demonstrated similar outcomes concerning the elimination of hypernasality, as well as for respiration, suggesting that accomplishment of pharyngeal flap after intravelar veloplasty did not provide better speech resonance outcomes nor favored respiration.

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Pharyngeal Flap and Sphincterplasty for Velopharyngeal Insufficiency Have Equal Outcome at 1 Year Postoperatively: Results of a Randomized Trial

Abstract: Despite strongly held views in the literature concerning the relative effectiveness and safety of flap and sphincter pharyngoplasty, no significant differences were detected 1 year postoperatively.

Cited by 108 publications

References 37 publications

Contractility of sphincter pharyngoplasty: Relevance to speech outcomes

Contractility of sphincter pharyngoplasty: Relevance to speech outcomes

Comparação entre cirurgia do retalho faríngeo e esfincteroplastia: análise nasométrica e aerodinâmica

Comparação entre duas abordagens diferentes de tratamento cirúrgico da insuficiência velofaríngea

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