title: Superiorly based pharyngeal flap for velopharyngeal insufficiency: intermediate and longer-term perceptual speech and nasometric outcomes.
abstract: OBJECTIVE
  To evaluate the intermediate and longer-term perceptual and objective speech outcomes in velopharyngeal insufficiency (VPI) patients treated with a superiorly based pharyngeal flap.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary care centre, London, Ontario.
  
  
  METHODS
  Forty consecutive VPI patients (mean age 14.5 years) from 2004 to 2008 who had a first time superiorly based pharyngeal flap were included. The modified Hogan flap and lateral port control technique was used with a 70° endoscope to provide intraoperative coaxial and magnified lateral port visualization.
  
  
  METHODS
  The American Cleft Palate-Craniofacial Association (ACPA) perceptual speech assessment and nasalance measured via nasometry using the MacKay-Kummer Simplified Nasometric Assessment Procedures Revised (SNAP-R). A comparison of mean outcomes from the pretreatment versus an intermediate (ACPA 4.3 months; SNAP-R 4.0 months) and longer-term (ACPA 19.5 months) posttreatment time point was performed, and the distribution of successful outcomes was assessed.
  
  
  RESULTS
  Mean perceptual scores improved significantly early after surgery (p < .0001; n  =  33) and in the longer term (p < .01; n  =  21), with high success rates for hypernasality (87.9% and 80.9%; p < .0001), audible nasal emission (90.9% and 90.5%; p < .0001), overall intelligibility (75.7% and 81.0%; p < .01), and compensatory articulation (81.8% and 85.7%; p < .01). Likewise, significant improvements were observed in posttreatment nasal (n  =  38; p < .01) and mean oral SNAP-R scores (n  =  39; p < .001), which demonstrated success rates of 100% (p < .0001) and 73% (p < .0001), respectively. Overcorrection was not observed in perceptual and nasometric testing.
  
  
  CONCLUSIONS
  The modified Hogan flap and lateral port control technique with the use of a 70° endoscope is highly successful in treating VPI. These results indicate that speech outcome improvement occurs early after surgery and is maintained over time.
authors: Department of Otolaryngology–Head and Neck Surgery, University of Western Ontario, Children’s Hospital, London Health Sciences Centre, ON.
authors: Shahin
authors: S
authors: Nabi
authors: Susan
authors: S
authors: Tan
authors: Murad
authors: M
authors: Husein
authors: Anne
authors: A
authors: Dworschak-Stokan
authors: Yves
authors: Y
authors: Bureau
authors: Damir
authors: D
authors: Matic
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D010614:Pharynx / Q000601:surgery*; D013065:Speech Intelligibility; D013524:Surgical Flaps; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000503:physiopathology / Q000601:surgery*; D014833:Voice Quality