title: Revisional surgery following the superiorly based posterior pharyngeal wall flap. Historical perspectives and current considerations.
abstract: The aim of this study was to describe the surgical and functional complications following superiorly based posterior pharyngeal wall (SBPP) flap surgery. Records of 130 patients with velopharyngeal insufficiency (VPI) who had undergone SBPP flap surgery as a secondary procedure to reduce nasal resonance in speech were reviewed. Complications were defined as the incidence of revisional surgery required to obtain a more satisfactory result. 20 patients (15%) required revisional surgery. In 4 patients (3%) early revisional surgery was indicated to treat surgical complications (1 postoperative bleeding, 3 flap dehiscences). In 16 patients (12%) late revisional surgery was indicated to achieve a better functional result with regard to nasal resonance in speech. The low incidence of surgical complications indicates that SBPP flap surgery is a safe procedure. After SBPP flap surgery, a satisfactory functional result with respect to nasal resonance was obtained in 88% of patients. This result was improved after revisional surgery. The hypothesis that the patients of an experienced surgeon have fewer complications and better functional results than those of a less experienced one was tested. The individual skill of the surgeon rather than their experience led to a better functional result.
authors.affiliation: Academic Medical Center, University of Amsterdam, Department of Oral and Maxillofacial Surgery, Amsterdam, The Netherlands. k.h.keuning@amc.uva.nl
authors.forename: K H D M
authors.initials: KH
authors.lastname: Keuning
authors.forename: G J
authors.initials: GJ
authors.lastname: Meijer
authors.forename: A
authors.initials: A
authors.lastname: van der Bilt
authors.forename: R
authors.initials: R
authors.lastname: Koole
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications / Q000601:surgery; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000601:surgery*; D014832:Voice Disorders / Q000209:etiology / Q000601:surgery; D055815:Young Adult