Dimensões nasofaríngeas e sintomas respiratórios após a cirurgia de retalho faríngeo em crianças e adultos

Abstract

Purpose: To investigate the influence of age on nasopharyngeal dimensions and respiratory symptoms in patients undergoing surgery to correct velopharyngeal insufficiency using the pharyngeal flap technique. Methods: A sample comprising 103 individuals divided into three groups: children (6-12 years old), young adults (18-30 years old) and middle-aged adults (≥ 40 years old). This was a retrospective study that analyzed the values for the nasopharyngeal area (pressure-flow technique, reference value: 0.570 cm 2 ) and the symptoms of oral respiration, snoring and respiratory difficulties during sleep. The values were obtained, on average, 12 months after surgery. The nasopharyngeal area was compared between the groups using analysis of variance, and respiratory symptoms were compared using the chi-squared test (p<0.05). Results

Comparação entre duas abordagens diferentes de tratamento cirúrgico da insuficiência velofaríngea

“…The effects of pharyngeal flap and secondary palatoplasty with intravelar veloplasty on the correction of speech symptoms (12,17,18,20,21) secondary to VPI and on the respiration of individuals (9,23,25) have been widely investigated and reported in the literature, in isolated manner. One of the few studies comparing the outcomes of these two surgeries on speech (10) demonstrated that pharyngeal flap was more efficient than intravelar veloplasty for reduction of hypernasality and adequacy of velopharyngeal closure in individuals with residual VPI.…”

“…One of the few studies comparing the outcomes of these two surgeries on speech (10) demonstrated that pharyngeal flap was more efficient than intravelar veloplasty for reduction of hypernasality and adequacy of velopharyngeal closure in individuals with residual VPI. Conversely, pharyngeal flap changes the anatomy of the velopharyngeal region and thus alters the permeability of the nasopharynx, possibly leading to undesirable respiratory symptoms as oral respiration, snoring, obstructive sleep respiratory disorders, and even hyponasality (9,15,23,26,27) . In all these studies, surgeries were performed as the single procedure for correction of VPI.…”

“…Even though intravelar veloplasty does not completely solve the speech symptoms in individuals with large gaps, some authors advocate the utilization of this procedure as first option for the treatment of VPI, since this is considered a more physiological procedure. Therefore, individuals requiring pharyngeal flap at a later moment, after veloplasty, may present a more favorable velopharyngeal condition, thus avoiding the indication of a broad flap and its undesirable effects on respiration (17,23) . Therefore, this study compared the results of pharyngeal flap surgery performed after palatoplasty with intravelar veloplasty (two-stage surgical approach) with the outcomes of pharyngeal flap surgery routinely performed at the hospital (single surgical stage), on speech nasality and respiration.…”