Recent Advances in Surgical Pharyngeal Modification Procedures for the Treatment of Velopharyngeal Insufficiency in Patients With Cleft Palate

Abstract

Background To review recent advances in pharyngeal modification procedures for the treatment of velopharyngeal insufficiency (VPI) in patients with cleft palate after primary repair. In addition, we discuss some of the advantages and disadvantages of the various pharyngoplasty techniques, as well as their safety and efficacy. Methods A review of frequently used pharyngeal modification techniques in correction of VPI was performed, and their advantages and disadvantages are outlined. Several techniques in pharyngoplasty most recently described in the literature are compared and contrasted. Results The goal of surgical pharyngeal modification procedures is to correct the abnormal failure of velopharyngeal closure. Multiple techniques used in VPI surgery have proven to be effective. They have similar adverse effect profiles, but what distinguishes them is likely their effectiveness in cases of severe VPI. Conclusions Velopharyngeal insufficiency is a problematic issue both for the patient and the treating surgeon. The negative effect of VPI on patients' quality of life has long been known, and over the years numerous techniques have been described to correct or improve this problem. Pharyngoplasty and pharyngeal flap or combination procedures are most effective in cases of severe VPI.

Diagnosis and Management of Velopharyngeal Insufficiency Associated with Chromosomal Syndromes

“…With these data the width of the flap or flaps necessary for achieving a complete closure can be determined. Also, the height at which the flap or flaps should be positioned in order to coincide with the maximum displacement of the velopharyngeal structures can be identified and even marked [4,14,[30][31][32].…”

“…In these cases, a preoperative neck CT-scan or a MRI -angiography is necessary in order to assess the trajectory of the internal carotid arteries and how superficial they are situated. This information allows assessment of the arterial anomalies in relation to the flap or flaps donor site [11,14,[30][31][32][33][34][35].…”

“…Thus, VNP and MVVF can be essential for indicating a tonsillectomy before pharyngeal flap or a sphincter pharyngoplasty. It has been reported that the postoperative prevalence of obstructive sleep apnea has been significantly reduced while maintaining good speech outcomes by a staged approach of removing tonsils and adenoids and by creating a short, high, wide superiorly based pharyngeal flap with superior advancement of the inferior posterior wall to close the donor site [11,[30][31][32][33][34][35].…”

“…Since they are inserted inferiorly, it is usually difficult to displace the flaps high enough in order to attach them at the necessary level for coinciding with the maximum displacement of the velum and lateral walls [4,11]. In sum, although tailor -made pharyngeal flap and sphincter pharyngoplasty have been described as reliable options for treating VPI in syndromic cases, some reports support the notion that the pharyngeal flap provides a better speech outcome [30][31][32].…”

Respiratory failure after superior-based pharyngeal flap for velopharyngeal insufficiency: A rare complication

“…The result is a patient with hypernasal speech, increased nasal resonance, and in some instances, nasal regurgitation of liquids and solids. Other common associations are poor speech intelligibility and speech delay [2]. The etiology can be congenital, associated with anatomic, functional, or neuromuscular abnormalities, or acquired during adenoidectomy [1,3].…”