Effectiveness of the Superiorly Based Pharyngeal Flap in Treating Velopharyngeal Insufficiency

Velopharyngeal insufficiency (VPI) is a condition characterized by failure of the posterior part of the soft palate to reach the pharyngeal wall and separate the nasopharynx from the oropharynx during speech and swallowing. VPI may persist following cleft palate repair. This study aimed to determine the outcomes of the superiorly based pharyngeal flap to treat VPI post cleft palate repair.

A retrospective cohort study included patients with VPI post cleft palate repair who underwent secondary speech surgery. The criteria were based on clinical symptoms, physical examination, nasometry, and videofluoroscopy/nasoendoscopy findings. Data were analyzed by using SPSS program, version 22.0. A P value less than 0.05 was considered significant.

Thirty-five patients were identified. VPI was reduced to 14.3% postoperatively. Before the surgery 25.7% of the patients had severe hypernasality, 68.6% had moderate hypernasality, and 5.7% had mild hypernasality. After the surgery, only 8.6% of the patients still had severe hypernasality, 22.9% had moderate hypernasality, 57.1% had mild hypernasality, and hypernasality became absent in 11.4%. Articulation disorders were present in 91.4% of patients before surgery, and decreased to 71.4% postoperatively. Speech intelligibility improved postoperatively in comparison with preoperative findings.

The present study concluded that the superiorly based pharyngeal flap was successful in treating VPI that persisted post cleft palate repair.