Pharyngeal Flap and Sphincter Pharyngoplasty for Velopharyngeal Insufficiency in Cleft Patients: A Systematic Review and Meta-Analysis

Velopharyngeal insufficiency (VPI) is caused by incomplete closure of the velopharyngeal port and can occur despite primary cleft palate repair. Pharyngeal Flap (PF) and Sphincter Pharyngoplasty (SP) are commonly used operations to treat VPI. This review aims to compare the efficacy of these operations in resolving VPI and assess speech outcomes and complications, including sleep apnea.

The PubMed, Embase, and World of Science databases were searched in October 2024. The title, abstract, and qualifying full-text article screening were performed by 2 authors, with a third author providing consensus. Articles including cleft palate patients and both procedures were included. The studies were then extracted and assessed for risk of bias using the Cochrane and Newcastle-Ottawa risk of bias tools. Meta-analysis was performed using a random effects model.

A total of 10 articles with 531 total patients were included in this study. Meta-analysis of VPI resolution and hypernasality yielded insignificant differences between PF and SP. Sleep apnea was shown to be significantly higher in PF patients after sensitivity analysis. Complication and reoperation rates were also found to be similar in patients receiving PF and SP.

PF and SP can both effectively treat VPI with similar rates of VPI resolution, hypernasality, and complications. However, SP had a reduced incidence of sleep apnea. Limitations of this study include a lack of standardization for reporting outcomes. Thus, prospective studies should report outcomes using standardized scales.