Surgery for speech in cleft palate patients.
BACKGROUND
Superiorly based pharyngeal flaps and sphincter pharyngoplasties are the two main possibilities for the surgical treatment of hypernasality in velopharyngeal dysfunction. Videonaspharyngoscopy and multi-view videofluoroscopy can provide anatomical and physiological data for planning these surgical procedures for correcting hypernasality.


OBJECTIVE
This study was undertaken to assess the planning and outcome of pharyngeal flaps and sphincter pharyngoplasties for correcting velopharyngeal insufficiency. The surgical techniques were customized according to the findings of videonasopharyngoscopy and multiview videofluoroscopy.


METHODS
Seventy patients with repaired palate clefts and residual velopharyngeal dysfunction were studied. The patients were randomly divided into two groups. The first group received a pharyngeal flap. The second group received a sphincter pharyngoplasty. Both procedures were individually customized according to the findings of videonasopharyngoscopy and multi-view videofluoroscopy.


RESULTS
There was a non-significant difference (P >0.05) between the mean size of preoperative velopharyngeal closure gap between the two groups of patients (mean=27.5%; S.D.=7.7% versus mean=28.3%; S.D.=5.9%). Postoperatively, velopharyngeal dysfunction was completely corrected in 89% of the cases from group 1, and in 85% of the cases from group 2. There was a non-significant difference (P >0.05) between the success rate for correcting VPI in both groups of patients.


CONCLUSIONS
Pharyngeal flap and sphincter pharyngoplasty seem to be safe and reliable procedures for treating residual velopharyngeal dysfunction. Although not all the patients studied for this paper achieved complete closure after the surgical procedures, all of them showed a reduction of the size of the velopharyngeal closure defect. The planning of the surgical procedure, in order to match the postoperative structure to the preoperative velopharyngeal dimensions and movements visualized through Videonasopharyngoscopy and videofluoroscopy, seems to be the most important aspect of the surgery for correcting residual velopharyngeal dysfunction.
Ysunza
Antonio
A
Hospital Gea Gonzalez, 4800 Calzada Tlalpan, Mexico D.F. 14000, Mexico. amysunza@terra.com.mx
Pamplona
Maria Carmen
MC
Molina
Fernando
F
Drucker
Mónica
M
Felemovicius
Jacobo
J
Ramírez
Elena
E
Patiño
Carmeluza
C
D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications / Q000601:surgery*; D006761:Hospitals; D006801:Humans; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D013064:Speech Disorders / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000150:complications / Q000601:surgery