Posterior Pharyngeal Flap and Sphincter Pharyngoplasty: The State of the Art

Abstract

Surgical management of velopharyngeal insufficiency by attachment of posterior pharyngeal flap or construction of sphincter pharyngoplasty is reviewed. Posterior pharyngeal flap surgery is well established, with a long history dating back to the 19th century. Flaps have been based superiorly, inferiorly, or laterally. There have been reports of airway obstruction and obstructive sleep apnea associated with posterior pharyngeal flap surgery. The concept of surgical creation of a dynamic sphincter pharyngoplasty to provide velopharyngeal closure was first introduced by Hynes in 1950. Hynes and others have proposed several subsequent anatomic modifications. Airway dysfunction has also been reported following sphincter pharyngoplasty, but may not be as frequent or severe as with posterior pharyngeal flap. While several studies have compared posterior pharyngeal flap and sphincter pharyngoplasty in terms of speech outcome or complications, there is not, as yet, a consensus regarding the specific choice of one versus the other for surgical management of velopharyngeal insufficiency.

Does division of pharyngeal flap operated for correction of velopharyngeal insufficiency affects speech results?

“…İlk bilinen deneyim Passavant tarafından 1865 yılında yumuşak damağın posterior faringeal duvara doğru-dan adhezyonu şeklinde gerçekleştirilmiştir (18) . İler-leyen yıllarda 1875 yılında Shoenborn velofaringeal yetmezliğin cerrahi tedavisinde en sık yeğlenen cerrahi girişim olan faringeal flep tekniğini tanımlamıştır (19) . Avrupa kıtasında tanımlanan bu prosedür ilerleyen dönemde Padgett tarafından Amerika Birleşik Devletleri'nde geniş serilere uygulanarak popülerize edilmiştir.…”

Obstructive sleep apnea in children with cleft lip and/or palate: Results of an epidemiologic study

“…Options for surgical management of VPI include pharyngeal flap or sphincter pharyngoplasty. Airway obstruction and OSA have been reported after both of these surgical procedures, but may be more frequent and severe after pharyngeal flap surgery [15]. For patients with evidence of OSA who present with VPI that requires surgical treatment, we suggest clinicians primarily consider sphincteroplasty to potentially avoid worsening of OSA.…”

Correlação entre fechamento velofaríngeo e dimensões nasofaríngeas após cirurgia de retalho faríngeo avaliados por meio da técnica fluxo-pressão

“…Há muitos anos tem-se investigado os efeitos da cirurgia sobre a fala e a respiração utilizando julgamento perceptivo associado ou não a métodos objetivos (10)(11)(12)(13)(14)(15)(16)(17)28,29) . As repercussões do retalho faríngeo têm sido objeto de estudo, também, no Laboratório de Fisiologia do HRAC-USP (4,6,21,22) .…”

“…Os dois orifícios posicionados lateralmente ao retalho devem ter diâmetro e permeabilidade suficientes para permitir a respiração nasal em repouso (9) . Muitos estudos relataram a efetividade do retalho farín-geo na redução dos sintomas da fala (4,6,(10)(11)(12)(13)(14)(15)(16)(17)(18) . Por outro lado, o retalho faríngeo está associado a um potencial e significante de comprometimento das vias aéreas superiores, incluindo-se entre esses comprometimentos desde a hiponasalidade, obstrução nasal crônica, até ronco e apnéia obstrutiva do sono, que podem trazer consequências graves aos pacientes (4,10,(19)(20)(21) .…”