ABSTRACT
Despite technical advances in cleft palate repairs, the post-surgical development of palatal fistulas and velopharyngeal insufficiency [VPI] is not uncommon. Approximately 20-38% of children who undergo cleft palate repair develop VPI. Surgical alteration of the VP sphincter is directed at decreasing the horizontal cross-sectional surface area of the sphincter's tissue boundaries. This can be achieved by the interposition of pedicled pharyngeal flaps [splitting one large port into two smaller one] or repositioning the posterior and lateral borders of the sphincter by the introduction of musculomucosal tissue flaps [Sphincteroplasty]. is to compare results of pharyngoplasty and superiorly based pharyngeal flap in the treatment of velopharyngeal insufficiency after cleft palate repair. A random group of twenty - two patients with VPI after cleft palate repair was studied. Patients were prone to three diagnostic procedures at phoniatric clinic, preoperatively: 1- Flexible fiber optic nasopharyngoscopy. 2-Nasometric evaluation 3-Tape recording. Patients were classified into two random groups; For 11 patients pharyngoplasty was done. Superiorly based pharyngeal flap was done for the rest of the patients. Nasometric evaluation and tape recording were repeated after phonotherapy [3-4 months postoperatively] and percentage drop in nasometer for nasal and oral sentences were calculated.Flexible fiber optic nasopharyngoscopy was repeated after 3 - 6 months postoperatively. In group I, three patients had persistence of nasal tone postoperatively [two patients had marked improvement and one patient had minimal improvement], giving incidence of complications 27.3%. According to results of postoperative tape recording of this group, 8 patients were categorized as good results, two as moderate and one as poor result. In group II, one patient had partial dehiscence and persistence of nasal tone postoperatively. Two patients had hypo nasality, one of them developed sleep apnea. Incidence of complications in this group was 27.3%. According to results of postoperative tape recording in this group, 9 patients were categorized as good results, one as moderate and one as poor result. Percentage drop in nasometer in nasal sentence in group I and II was 35.55% and 42.61% respectively. Percentage drop in nasometer in oral sentence in group I and II was 51.95% and 49.11% respectively. Both sphincter pharyngoplasty and superiorly based pharyngeal flap proved to be effective in treatment of velopharyngeal insufficiency with accepted incidence of complications. Sphincter pharyngoplasty had better results in patients with good palatal and lateral pharyngeal wall movements on preoperative videoendoscopy. Superiorly based pharyngeal flap had better results in patients with poor palatal and lateral pharyngeal wall movements on preoperative videoendoscopy