Outcomes of Combined Furlow Palatoplasty and Sphincter Pharyngoplasty for Velopharyngeal Insufficiency

Abstract

Objectives: Compare surgical outcomes between pharyngeal flap, sphincter pharyngoplasty, and concomitant Furlow palatoplasty and sphincter pharyngoplasty in the management of pediatric velopharyngeal insufficiency. Methods: Retrospective review of 96 patients with velopharyngeal insufficiency, who underwent surgical intervention at a tertiary pediatric care center between 2008 and 2012. Patients with velocardiofacial syndrome were excluded from the study. Surgical interventions were categorized as pharyngeal flap, sphincter pharyngoplasty, and concomitant Furlow palatoplasty and sphincter pharyngoplasty. Main outcome measures included perceptual speech analyses, complications, and surgical revision rates. Results: Of the 96 reviewed patients, 38 (39.6%) underwent pharyngeal flap, 20 (20.8%) sphincter pharyngoplasty, and 38 (39.6%) concomitant Furlow palatoplasty and sphincter pharyngoplasty. The mean improvement in postoperative perceptual speech analysis scores was significantly higher in both the combined procedure and pharyngeal flap when compared to sphincter pharyngoplasty alone ( P = .013, P = .031). No statistically significant difference in speech improvement was observed between the combined procedure and pharyngeal flap. There were no differences in complications among the three surgical interventions. However, the combined procedure required significantly less surgical revisions than the pharyngeal flap ( P = .019). Conclusions: Concomitant Furlow palatoplasty and sphincter pharyngoplasty is an effective procedure for the management of pediatric velopharyngeal insufficiency and may result in superior speech outcomes and lower revision rates than sphincter pharyngoplasty and pharyngeal flap, respectively.

Comparação entre cirurgia do retalho faríngeo e esfincteroplastia: análise nasométrica e aerodinâmica

“…On the other hand, a recent study showed that the sphincteroplasty combined with the Furlow technique, as well as the pharyngeal flap, were significantly more efficient in reducing hypernasality than the sphincteroplasty performed in isolation 28 . However, it is worth emphasizing that a limitation of this study was the fact that the authors employed only perceptual assessment of speech for analyzing results, without, however, evaluating concordance between examiners.…”

“…Among those surgical techniques employed in VPI treatment, pharyngeal flap and sphincteroplasty are still the most used in different craniofacial centers in the world 12,28,[32][33][34] and the literature has demonstrated the success and the deleterious effects of both these surgical techniques used in VPI treatment secondary to primary palatoplasty. Most studies used the perceptual methodology and/or direct instrumental methods for evaluation velopharyngeal function, such as nasoendoscopy and videofluoroscopy 12, [19][20][21][22] .…”

“…Therefore, the pharyngeal flap was more efficient than intravelar veloplasty for correcting hypernasality and for adequate velopharyngeal closure 26 . Sphincteroplasty surgical results have also been frequently compared to other surgical techniques, in isolation or combined, aimed at establishing the most effective technique for correcting velopharyngeal insufficiency 12, 21,28 . A large group of researchers compared the speech results obtained before and after sphincteroplasty in 45 individuals, and the pharyngeal flap in 52 individuals, using perceptual, nasometric and nasoendoscopy evaluations.…”

Respiratory failure after superior-based pharyngeal flap for velopharyngeal insufficiency: A rare complication

“…If a patient continues to have hypernasal speech, surgical repair is planned when the child is aged 3 or 4 years [1]. Numerous approaches to the surgical repair of VPI have been reported, including superior-based pharyngeal flap, sphincter pharyngoplasty, Furlow palatoplasty, and augmentation pharyngoplasty, and calcium hydroxylapatite or autologous fat injection [1][2][3][4]. Selection of which procedure(s) best suits each patient is highly individualized, taking into consideration suspected etiology, anatomic gap, age, syndromes, and many other factors.…”

“…Complications documented in the literature include bleeding, aspiration, airway obstruction requiring reintubation/tracheotomy, flap dehiscence, and nasopharyngeal stenosis; however, the complication that has received the most attention is post-operative obstructive sleep apnea [1,4]. To our knowledge, respiratory failure has only been documented twice in recent literature and it was related to a central nervous system insult [5].…”