title: Posterior pharyngeal augmentation in the treatment of velopharyngeal insufficiency: a 40-year experience.
abstract: BACKGROUND
  Velopharyngeal insufficiency (VPI) remains a common problem in the care of patients with cleft palate and other related conditions. It may be successfully corrected with augmentation of the posterior pharynx. The purpose of this study was to review the experience and results of posterior pharyngeal augmentation over a 40-year period at one cleft center in the United States.
  
  
  METHODS
  All patients from 1968 to 2008 who underwent posterior pharyngeal augmentation for the treatment of VPI were reviewed retrospectively. Diagnosis, age at the time of operation, type of implant used, duration of follow-up, speech performance both pre- and postoperatively, and complications were analyzed. Speech performance preoperatively was assessed by video fluoroscopy and/or nasoendoscopy. Resonance was assessed by both the surgeon and speech pathologist using a 4 point grading scale.
  
  
  RESULTS
  One hundred eleven patients underwent posterior pharyngeal augmentation. Thirteen patients required removal of the implant because of extrusion (n = 12) or postoperative sleep apnea (n = 1). Five patients with failed implants at the primary operation had successful replacement at a second operation, resulting in a retained implant success rate of 93%. Of the 103 patients who were successfully augmented, 15 were lost to follow-up, leaving 88 patients with full postoperative speech evaluations. Of the 88 patients evaluated, 64 exhibited normal or near normal speech (73%), 22 patients had mildly nasal speech (25%), and 2 patients (2%) were not improved. Highest extrusion rates were seen for smooth surface silicone and rolled gortex implants.
  
  
  CONCLUSIONS
  Augmentation of the posterior pharyngeal wall is a safe and effective treatment for patients with VPI. Implants are well tolerated and speech is substantially improved.
authors.affiliation: Cronin and Brauer Cleft Clinic, St. Joseph Medical Center, Houston, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lypka
authors.forename: Rafi
authors.initials: R
authors.lastname: Bidros
authors.forename: Murtaza
authors.initials: M
authors.lastname: Rizvi
authors.forename: Mark
authors.initials: M
authors.lastname: Gaon
authors.forename: Adam
authors.initials: A
authors.lastname: Rubenstein
authors.forename: Donna
authors.initials: D
authors.lastname: Fox
authors.forename: Ernest
authors.initials: E
authors.lastname: Cronin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010614:Pharynx / Q000601:surgery*; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D012086:Reoperation; D012189:Retrospective Studies; D012828:Silicones; D013018:Sound Spectrography; D013061:Speech Acoustics; D013064:Speech Disorders / Q000209:etiology; D014681:Velopharyngeal Insufficiency / Q000601:surgery*; D014741:Video Recording; D055815:Young Adult
chemical_list: D012828:Silicones; D011138:Polytetrafluoroethylene