Precision Pharyngeal Flap: An Individualized, Patient-Specific Surgery for the Treatment of Velopharyngeal Insufficiency

Abstract

Background:The pharyngeal flap is one of the most common secondary surgeries for the correction of velopharyngeal insufficiency (VPI) for patients with cleft palate and/or cleft lip and palate. This study aimed to demonstrate the effectiveness of the precision pharyngeal flap surgery performed by the senior author. Materials and Methods: Children with VPI, who underwent precision pharyngeal flap, were retrospectively examined. All surgical procedures were performed by the senior author. The flap size was individually configured based on the patients' preoperative nasopharyngoscopic analysis and speech function evaluation. Pre-and post-operative velopharyngeal functions were assessed using perceptual speech evaluation and nasometric analysis; factors affecting surgical outcomes were determined. Results: Of 138 patients, 112 (women: 53, men: 59) were included in analyses, according to the inclusion and exclusion criteria. The median follow-up period was 21 months (range: 9-120). Postoperative perceptual speech evaluation revealed improved velopharyngeal function in 108 (96.4%). There were no reports of postoperative hyponasality (preoperative, 1.8% versus postoperative, 0%; P ¼ 0.053). Other parameters of perceptual speech evaluation (hypernasality, nasal emission, articulation error, and intelligibility) showed significant improvement postoperatively (P < 0.01). Postoperative nasalance scores revealed sufficient postoperative resonance rating in 96% of patients. No patients experienced postoperative complications (bleeding, airway obstruction, and surgical wound dehiscence).Conclusions: Individually configured pharyngeal flaps designed based on preoperative nasopharyngoscopic examination coupled with precise surgical techniques led to the high surgery success rate for VPI treatment.

Treatment of VPI with Customized Pharyngeal Flaps: One Size Does Not Fit All

“…The success rate of 92% is comparable to other studies that place the success rate of pharyngeal flap surgery in the range of 81.5%–97%. 5 The data of this study expand upon previous research through the addition of a surgeon and a wider variation in technique. A single-surgeon study by Baek et al demonstrated that preoperative planning using FVNP resulted in velopharyngeal competency in 96% of patients.…”

“…The success rate of 92% is comparable to other studies that place the success rate of pharyngeal flap surgery in the range of 81.5%-97%. 5 The data of this study expand upon previous research through the addition of a surgeon and 5 Our study encompassed a larger number of surgeons and surgical techniques but produced comparable outcomes due to preoperative planning and anatomic information using MPVF and FVNP. All 35 cases of VCFS underwent a neck CT scan with contrast before T&A, followed by pharyngeal flap creation.…”

“…A single-surgeon study by Baek et al demonstrated that preoperative planning using FVNP resulted in velopharyngeal competency in 96% of patients. 5 Our study encompassed a larger number of surgeons and surgical techniques but produced comparable outcomes due to preoperative planning and anatomic information using MPVF and FVNP.…”

“…This muscle group acts in coordinated and balanced constriction, allowing for the correct resonance and articulation of phonemes. [1][2][3][4][5] Failure of the VPS to completely close causes velopharyngeal insufficiency (VPI), which manifests as nasal resonance or hypernasality, nasal airway emission, and in some cases, compensatory articulation patterns, which severely interfere with intelligibility and quality of speech.…”