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Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction

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AlloDerm revision for failed pharyngoplasty.

David A Kelly¹, Christina Plikatitis, David Blalock

¹Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center, Winston Salem, NC 27157, USA.

The Journal of Craniofacial Surgery

|May 9, 2012

Summary

Revision pharyngoplasty with an AlloDerm sling effectively treats persistent velopharyngeal insufficiency (VPI) after cleft palate surgery. This surgical technique significantly improves speech resonance and reduces nasalance in affected children.

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Area of Science:

Plastic Surgery
Speech Pathology
Craniofacial Surgery

Background:

Velopharyngeal insufficiency (VPI) affects over 20% of patients post-cleft palate repair.
Persistent VPI after initial pharyngoplasty occurs in more than 20% of cases.
Surgical revision aims to narrow the nasopharynx and improve palatal closure.

Purpose of the Study:

To evaluate the efficacy of AlloDerm sling revision pharyngoplasty for persistent VPI.
To assess speech outcomes and nasalance reduction in pediatric patients.

Main Methods:

16 children with persistent VPI underwent revision surgery using an AlloDerm sling.
Patients had a history of at least one failed pharyngoplasty (sphincter pharyngoplasty or pharyngeal flap).
Preoperative and postoperative speech assessments and acoustic nasometry were performed.

Main Results:

93.8% of patients showed significant improvement in perceptual resonance.
87.5% achieved normal or mild resonance (P < 0.001).
A significant reduction in nasalance was observed (P < 0.001).

Conclusions:

AlloDerm sling revision pharyngoplasty is a safe and effective treatment for persistent VPI.
The procedure significantly improves speech and resonance in patients with cleft palate.
Further long-term follow-up studies are warranted.