Results with sphincter pharyngoplasty and pharyngeal flap.
OBJECTIVE
To evaluate speech outcomes and complications of sphincter pharyngoplasty and pharyngeal flap performed for management of velopharyngeal insufficiency (VPI).


METHODS
Case series.


METHODS
Tertiary care children's hospital.


METHODS
All patients who underwent pharyngeal flap or sphincter pharyngoplasty from 1990 to 1995.


METHODS
Perceptual speech analysis was used to assess severity of VPI, presence of nasal air emissions and quality of nasal resonance (hyper, hypo, or normal). Pre-operative measures of velopharyngeal function were based upon nasendoscopy and videofluoroscopic speech assessment. Recommendations for management were made by the attending surgeon. Complications of hyponasality and obstructive sleep symptoms (OSS) were noted. Patient characteristics were compared using univariate analysis.


RESULTS
Sixteen patients underwent sphincter pharyngoplasty and 18 patients underwent superiorly based pharyngeal flap. Patients were similar in terms of lateral pharyngeal wall medial motion and palatal elevation. The groups were also similar with regard to VPI severity, though there was a trend for more severe VPI in patients undergoing sphincter pharyngoplasty than pharyngeal flap (50 vs. 33.3%, respectively). Patients with pharyngoplasty had a higher rate of resolution of VPI than those who had pharyngeal flap (50 vs. 22.2%, respectively), although this was not statistically significant. Post-operative hyponasality and obstructive sleep symptoms were present in both groups. However, only patients who underwent PF and had postoperative OSS had obstructive sleep apnea (OSA).


CONCLUSIONS
There were no detectable anatomic differences between treatment groups implying that treatment selection during the study period was not guided by strict anatomic criteria. Sphincter pharyngoplasty may have a higher success rate with a lower risk of OSS.
de Serres
L M
LM
Department of Otolaryngology-Head and Neck Surgery, University of Washington, and Children's Hospital and Regional Medical Center, Seattle, USA.
Deleyiannis
F W
FW
Eblen
L E
LE
Gruss
J S
JS
Richardson
M A
MA
Sie
K C
KC
D002648:Child; D002972:Cleft Palate / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010160:Palate, Soft / Q000601:surgery*; D010609:Pharyngeal Muscles / Q000503:physiopathology* / Q000637:transplantation*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013060:Speech / Q000502:physiology; D013065:Speech Intelligibility; D013524:Surgical Flaps; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis / Q000601:surgery*