Unilateral Moore pharyngoplasty in the treatment of unilateral or asymmetric velopharyngeal incompetence.
OBJECTIVE
To describe the use of a unilateral modification of the Moore pharyngoplasty in the treatment of unilateral or asymmetric velopharyngeal incompetence (VPI) and analyze the results in a consecutive series of patients operated on by a single surgeon.


METHODS
Blind assessment of randomized speech and nasendoscopy recordings.


METHODS
A two-site tertiary referral cleft unit.


METHODS
Eighteen consecutive patients with asymmetrical or unilateral VPI of varying etiology.


METHODS
A unilateral Moore pharyngoplasty was performed in all patients. Three patients underwent radical dissection and retropositioning of the velar muscles at the same time as the unilateral Moore pharyngoplasty.


METHODS
Pre- and postoperative nasality and nasal airflow using the CAPS score, assessment of nasendoscopy recordings, and the rate of further surgery.


RESULTS
There was a significant improvement in hypernasality (p =.014). There was a highly significant decrease in the size of the velopharyngeal gap on the side on which the Moore pharyngoplasty was performed (p =.004) as well as a highly significant decrease in the total gap size (p =.003). The Moore flap was effective in obliterating the lateral pharyngeal recess in 11 of 12 patients (p =.004). Three patients required further velopharyngeal surgery.


CONCLUSIONS
In appropriately selected patients, a unilateral Moore pharyngoplasty is a safe and effective treatment for unilateral or asymmetric VPI. If indicated, a radical dissection and retropositioning of the velar muscles may be combined with a Moore pharyngoplasty.
Mehendale
Felicity V
FV
Great Ormond Street Hospital, London WC1N 3JH, England, UK. felicity@gosh.nhs.uk
Sommerlad
Brian C
BC
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery*; D014833:Voice Quality