Outcomes in Velopharyngeal Dysfunction Treatment: Comparing Two Approaches for Pharyngeal Flaps

Area of Science:

• Otolaryngology
• Speech-Language Pathology
• Surgical Outcomes

Background:

• The posterior pharyngeal flap (PPF) is a common surgical treatment for velopharyngeal dysfunction in the US.
• Two primary techniques exist: palatal split (PS) and fish mouth (FM).

Purpose of the Study:

• To compare surgical and speech outcomes between the palatal split (PS) and fish mouth (FM) techniques for posterior pharyngeal flap (PPF) surgery.
• To evaluate the efficacy of different PPF surgical approaches in treating velopharyngeal dysfunction.

Main Methods:

• Retrospective chart review of 87 PPF cases performed between 2008 and 2016.
• Data collected included age, operative length, length of stay (LOS), revisional surgery, and pain medication.
• Speech outcomes assessed by Speech Language Pathologists using Universal Parameters for Reporting Speech Outcomes.

Main Results:

• The fish mouth (FM) technique showed a significantly shorter LOS (26.20 hours vs. 32.86 hours) and less acetaminophen use compared to the palatal split (PS) technique.
• The FM technique had a significantly lower revisional surgery rate (2.1% vs. 17.5%) and reduced postoperative hypernasality (0.29 vs. 0.61).
• Syndromic patients were more frequently treated with the FM technique (29.8% vs. 15%).

Conclusions:

• The fish mouth (FM) technique is associated with improved surgical outcomes, including shorter LOS and reduced revision rates.
• The FM technique demonstrated more favorable speech outcomes, specifically less hypernasality, compared to the palatal split (PS) technique.
• These findings suggest the FM technique may be a preferred surgical approach for posterior pharyngeal flap procedures.