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Outcomes After Pharyngeal Flap Surgery in Children: A Comparison of Lined Versus Unlined Flaps
Colin Fuller1, J Reed Gardner2, Olivia Speed2
1Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma, Oklahoma City, OK, USA.
Insights
The uvular flap (PFU) pharyngeal flap surgery may offer improved outcomes for velopharyngeal dysfunction compared to standard pharyngeal flap (PF). PFU demonstrated better speech analysis results and fewer revision surgeries without increased complications.
Area of Science:
- Plastic Surgery
- Speech-Language Pathology
- Otolaryngology
Background:
- Velopharyngeal dysfunction (VPD) significantly impacts speech clarity.
- Standard pharyngeal flap (PF) surgery is a common treatment for VPD.
- The uvular flap (PFU) is a modification of PF surgery hypothesized to improve outcomes.
Purpose of the Study:
- To compare the surgical outcomes of PF versus PFU in children with VPD.
- To evaluate differences in complications, revision rates, and speech measures between PF and PFU.
Main Methods:
- Retrospective cohort study of 160 children undergoing PF or PFU between 2004-2017.
- Analysis of complications, revision surgery frequency and type, and speech outcomes (nasometry, pressure-flow testing, perceptual speech analysis).
Main Results:
- PFU patients were older and more likely to have cleft palate.
- No significant difference in overall complications between PF and PFU.
- PFU was associated with a lower rate of revision surgeries (p=0.002) and improved perceptual speech analysis scores (p=0.009).
- Nasometry showed significant differences favoring PFU (p=0.001), while pressure-flow testing did not (p=0.525).
Conclusions:
- The uvular flap modification may lead to improved long-term surgical outcomes for VPD.
- PFU is associated with better subjective and objective speech test results and a reduced need for revision surgery.
- PFU appears to be a safe alternative to standard PF surgery, without increasing complications.
Objective:
The addition of a uvular flap (PFU) was hypothesized to improve outcomes over standard pharyngeal flap (PF) for correction of velopharyngeal dysfunction. We report differences in outcomes of PF vs PFU at our institution.
Design:
Retrospective cohort study.
Setting:
Tertiary children's hospital.
Patients:
Children who underwent PF or PFU with the three highest-volume surgeons at our institution in 2004-2017.
Outcome Measures:
We examined differences in complications between groups, frequency and type of revision surgery, and speech-related measures including nasometry, pressure-flow testing (PFT) and perceptual speech analysis (PSA).
Results:
160 patients were included, 41 PF and 119 PFU (including 18 with Hogan technique). Patients undergoing PFU were older (7.6 yr vs 6.0 yr; p = 0.037) and more likely to have cleft palate (63/119 vs 14/41; p = 0.047). There was no significant difference in complications. With PFU, a decrease in airspace contracting revision surgeries was noted, (4/119 vs 8/41; p = 0.002) which drove a reduction in revision surgery of all types (7/119 vs 13/41; p = 0.033). However, patients that did undergo revision surgery after PFU underwent more revision procedures (p = 0.032). PSA scores were found to be lower (less hypernasal) after PFU (p = 0.009) compared to PF. Objective speech measures had varying results, with nasometry demonstrating a significant difference between groups (p = 0.001), while PFT (p = 0.525) did not demonstrate a statistical difference.
Conclusion:
The use of a uvular lining flap in pharyngeal flap surgery may be associated with improved long term surgical outcomes, including both improvements in subjective and objective testing and a lower rate of revision surgery, without increased complications.
