Prospective Evaluation of the Outcome of Velopharyngeal Insufficiency Therapy after Simultaneous Double Z-Plasty and Sphincter Pharyngoplasty

Abstract

Objective: One of the main goals in the management of cleft palate is to achieve a good quality of speech. The aim of the prospective study was to evaluate the effectiveness of therapy in patients with velopharyngeal insufficiency treated by simultaneously performed Furlow and Orticochea operations. Patients and Methods: From May 2007 to May 2008 we treated 14 consecutive patients (6 males and 8 females, mean age 14 years). The indications for surgery were based on nasofiberscopic examination, evaluation of speech quality, nasometry and morphology of the palate. The velopharyngeal closure was below 80% in all the patients; they had pronounced nasality and limited intelligibility of speech. All the palates were short. Results: The final outcome of treatment was based on the combined evaluation of 4 parameters: closure, speech intelligibility, nasality and the nasalance index. Ten patients achieved full recovery (71%), the remaining 4 had improved recovery (29%). Conclusion: A 1-stage Furlow operation and sphincter pharyngoplasty are an effective modality in the therapy of velopharyngeal insufficiency. Indications for posterior pharyngeal flap pharyngoplasty should be limited to the cases in which a simultaneous Furlow operation and sphincter pharyngoplasty are not possible due to a deficit of the palatine tissue.

Outcomes of Combined Furlow Palatoplasty and Sphincter Pharyngoplasty for Velopharyngeal Insufficiency

“…More recently, a small number of case series have suggested increased efficacy of concomitant Furlow palatoplasty and sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency 3,10‐12 . Theoretically, this surgical approach accomplishes both palatal lengthening and circumferential narrowing of the velopharyngeal port, thereby creating a more physiologic sphincter mechanism.…”

“…7,8 More recently, a small number of case series have suggested increased efficacy of concomitant Furlow palatoplasty and sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency. 3,[10][11][12] Theoretically, this surgical approach accomplishes both palatal lengthening and circumferential narrowing of the velopharyngeal port, thereby creating a more physiologic sphincter mechanism. However, in the current literature, this innovative surgical approach has typically been reserved for children with a large velopharyngeal gap and poor lateral wall motion as demonstrated by preoperative endoscopy.…”

“…However, in the current literature, this innovative surgical approach has typically been reserved for children with a large velopharyngeal gap and poor lateral wall motion as demonstrated by preoperative endoscopy. 10,12 We hypothesize that combined Furlow palatoplasty and sphincter pharyngoplasty will result in better surgical outcomes than either posterior pharyngeal flap or sphincter pharyngoplasty alone in the pediatric VPI population regardless of preoperative velopharyngeal characteristics.…”

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

“…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] .…”