Evaluating Surgical Outcomes: A Comparative Analysis of 2 Techniques for Sphincter Pharyngoplasty

Sphincter pharyngoplasty (SP) is a well-established surgical strategy for correcting velopharyngeal insufficiency (VPI) after cleft palate repair. SP can be performed with flap inset in either an end-to-end (ETE) or overlapping pattern. In this study, the authors compared the relative efficacy of ETE versus overlapping inset in patients undergoing SP for VPI.

A retrospective review was conducted of patients with VPI who underwent SP at a major children's hospital between 2007 and 2023. Patient data collection included demographic characteristics, speech outcomes, and polysomnography results. Statistical analysis was performed using Mann-Whitney U and chi-square tests.

Ninety patients underwent SP, with 44 (49%) in the ETE group and 46 (51%) in the overlapping group. Patients with overlapping inset had better speech outcomes, with 56.5% achieving balanced resonance compared with 34.1% in the ETE group ( P = 0.033). Patients in the ETE group also had more compensatory speech errors (34.1% versus 8.7% [ P = 0.003]). Patients in the overlapping inset group had significantly higher rates of obstructive sleep apnea and a higher apnea-hypopnea index (8.2 versus 3.1 [ P = 0.039]).

SP with overlapping inset is associated with improved speech outcomes but greater risk of obstructive sleep apnea. The choice of inset pattern should be carefully considered to balance these considerations.