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Pharyngeal flap surgery: long-term outcomes at the University of Iowa
Benjamin B Cable1, John W Canady, Michael P Karnell
1Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Insights
Pharyngeal flap surgery effectively treats velopharyngeal insufficiency in children. Resonance performance remains adequate and may improve with growth, supporting this surgical approach.
Area of Science:
- Plastic Surgery
- Speech-Language Pathology
- Pediatric Otolaryngology
Background:
- Velopharyngeal insufficiency (VPI) is a common complication in cleft palate and craniofacial patients.
- The pharyngeal flap is a widely adopted surgical technique for managing VPI.
Purpose of the Study:
- To evaluate the short-term and long-term effectiveness of pharyngeal flap surgery in pediatric patients.
- To assess the impact of the pharyngeal flap on speech resonance and velopharyngeal competence.
Main Methods:
- Retrospective review of pediatric patients undergoing pharyngeal flap surgery (1970-2000).
- Speech assessments conducted 2-5 years postoperatively.
- Evaluation of hypernasality and hyponasality (1-6 scale) and velopharyngeal competence (1-3 scale).
Main Results:
- Overall resonance performance was found to be adequate in the long term.
- Resonance outcomes demonstrated potential for improvement with patient growth and maturation.
- Velopharyngeal competence was maintained or improved post-surgery.
Conclusions:
- Pharyngeal flap surgery is a successful treatment for velopharyngeal insufficiency in children.
- The procedure yields sustained or improved speech resonance and velopharyngeal function over time.
- Findings support the continued use of pharyngeal flaps in managing pediatric VPI.
Abstract:
The pharyngeal flap is the most often used surgical approach to treat the problem of velopharyngeal insufficiency, a common challenge encountered in cleft palate and craniofacial clinics. The authors retrospectively reviewed short-term and long-term measures of children treated with the pharyngeal flap at the University of Iowa Cleft and Craniofacial Center. All patients who underwent pharyngeal flap surgery between January of 1970 and December of 2000, with at least one postoperative speech assessment between 2 and 5 years after the operation, were identified. Both hypernasality and hyponasality were evaluated on a scale from 1 to 6, with 1 indicating no involvement and 6 indicating severe effect on resonance. Velopharyngeal competence was also rated on a scale of 1 to 3, with 1 indicating competence and 3 indicating incompetence. These short-term data were then compared. The results showed that overall resonance performance continues to be adequate and may even improve as the patient continues to grow and mature. These findings support the use of the pharyngeal flap in the treatment of children with velopharyngeal insufficiency.
