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Salvaging the failed pharyngoplasty: intervention outcome

P D Witt1, T Myckatyn, J L Marsh

  • 1Cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital, Washington University School of Medicine, Missouri 63110, USA. witt@msnotes.wustl.edu

The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association
|October 7, 1998
PubMed
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Surgical management of velopharyngeal dysfunction using pharyngeal flap or sphincter pharyngoplasty has similar failure rates. Revisional surgery can successfully correct velopharyngeal closure but may result in denasal speech.

Area of Science:

  • Otolaryngology
  • Speech Pathology
  • Surgical Outcomes

Background:

  • Velopharyngeal dysfunction (VPD) requires surgical intervention when conservative methods fail.
  • Pharyngeal flap and sphincter pharyngoplasty are common surgical procedures for VPD.
  • Understanding failure rates and revision outcomes is crucial for patient management.

Purpose of the Study:

  • To determine the failure rates of primary pharyngeal flap and sphincter pharyngoplasty surgeries for VPD.
  • To evaluate the outcomes of revisional surgery for patients who failed primary procedures.
  • To identify the causes of surgical failure in these VPD management techniques.

Main Methods:

  • Retrospective evaluation of 65 patients undergoing primary pharyngeal flap and 123 patients undergoing primary sphincter pharyngoplasty for VPD.

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  • Surgical failure defined by persistent hypernasality, nasal turbulence, and incomplete velopharyngeal closure.
  • Pre- and post-operative speech evaluations and instrumental assessments (fluoroscopy, nasendoscopy) were performed.

    • Main Results:

    • Primary pharyngeal flap failure rate was 20% (13/65), with 8/13 successfully revised in one operation.
    • Primary sphincter pharyngoplasty failure rate was 16% (20/123), with 17/20 successfully revised.
    • Partial or complete flap dehiscence was the primary cause of failure for both procedures.

    Conclusions:

    • Pharyngeal flap and sphincter pharyngoplasty exhibit comparable primary failure rates.
    • Revisional surgery is effective in achieving velopharyngeal closure, salvaging failed primary operations.
    • Revisional surgery for VPD often leads to secondary denasal speech without significant airway compromise.