Correction of post-palatoplasty velopharyngeal insufficiency by two different techniques

ABSTRACT

Evaluation the success of 2 different techniques in treating post-palatoplasty residual velopharyngeal insufficiency [VPI]. Prospective study on 48 cases of post-palatopl asty hypernasality. The cases classified into 3 groups according to the type of velopharyngeal closure. Group A had coronal closure pattern and treated by sphincter pharyngoplasty, group B had sagittal closure pattern and treated by pharyngeal flap and group C had circular closure pattern and treated by sphincter pharyngoplasty. Postoperative follow-up by flexible nasopharyngoscopy, auditory perceptual assessment and parent's questionnaire. The incidence of residual VPI after sphincter pharyngoplasty was 11.5% while it was 9% after pharyngeal flap [p value=0.784]. The satisfactory speech improvement was 88.5% for cases underwent sphincter pharyngoplasty and 91% for cases underwent pharyngeal flap [p value=0.784]. The incidence of snoring was 3.8% for cases underwent sphincter pharyngoplasty and 27% for cases underwent pharyngeal flap [p value=0.038]. No cases developed sleep apnea after pharyngoplasty while it was developed in 13.5% after pharyngeal flap [p value=0.089]. No statistically significant difference in outcomes between the 2 procedures for speech assessment score [p value=0.540]. Mobility was detected in the flaps of sphincter pharyngoplasty while the posterior pharyngeal flaps were static. Sphincter pharyngoplasty and pharyngeal flap are good operations for correction of post-palatoplasty hypernasality. But in cases with circular closure pattern, sphincter pharyngoplasty is the operation of choice as it carries low risk of obstructive complications and it is dynamic