DOI QR코드

DOI QR Code

Outcomes of a superiorly-based pharyngeal flap for the correction of velopharyngeal dysfunction

  • Lee, Yong Woo (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine) ;
  • Bae, Yong Chan (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine) ;
  • Park, Sang Min (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine) ;
  • Nam, Soo Bong (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine) ;
  • Seo, Hyung Joon (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine) ;
  • Kim, Geon Woo (Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine)
  • Received : 2019.12.03
  • Accepted : 2020.01.24
  • Published : 2020.02.20

Abstract

Background: This study investigated the outcomes of pharyngeal flap surgery in Asian patients with velopharyngeal dysfunction (VPD), with a focus on postoperative improvements in speech articulation and complications. Additionally, this study explored whether the cause of VPD and the timing of surgery affected outcomes in terms of speech improvement. Methods: A retrospective review was conducted of the medical records of 72 Asian VPD patients who underwent pharyngeal flap surgery performed by a single surgeon from 1996 to 2014. Operative complications were analyzed for all 72 patients, and preoperative and postoperative speech articulation tests were compared for the subset of 43 patients in whom such testing was possible. The relationships of age at surgery and the cause of VPD with the extent of improvement in speech articulation were also investigated. Results: Nine of the 72 patients (13%) experienced wound-related complications. Furthermore, 34 patients (47%) reported persistent snoring lasting for over 3 months, and 16 (22%) reported snoring for over 1 year. Three patients (4%) underwent reoperation. Speech articulation scores significantly improved postoperatively across all groups. Younger age at surgery was associated with greater improvements in speech outcomes, but no significant relationship was found between the cause of VPD and the extent of the postoperative improvement in speech outcomes. Conclusion: Speech outcomes improved after pharyngeal surgery in Asian patients with VPD. Early surgery was associated with favorable speech outcomes, but no association was found between the cause of VPD and postoperative speech outcomes.

Keywords

References

  1. Valnicek SM, Zuker RM, Halpern LM, Roy WL. Perioperative complications of superior pharyngeal flap surgery in children. Plast Reconstr Surg 1994;93:954-8. https://doi.org/10.1097/00006534-199404001-00009
  2. Fraulin FO, Valnicek SM, Zuker RM. Decreasing the perioperative complications associated with the superior pharyngeal flap operation. Plast Reconstr Surg 1998;102:10-8. https://doi.org/10.1097/00006534-199807000-00002
  3. Becker DB, Grames LM, Pilgram T, Kane AA, Marsh JL. The effect of timing of surgery for velopharyngeal dysfunction on speech. J Craniofac Surg 2004;15:804-9. https://doi.org/10.1097/00001665-200409000-00020
  4. Seyfer AE, Prohazka D, Leahy E. The effectiveness of the superiorly based pharyngeal flap in relation to the type of palatal defect and timing of the operation. Plast Reconstr Surg 1988;82:760-4. https://doi.org/10.1097/00006534-198811000-00005
  5. Leanderson R, Korlof B, Nylen B, Eriksson G. The age factor and reduction of open nasality following superiorly based velopharyngeal flap operation in 124 cases. Scand J Plast Reconstr Surg 1974;8:156-60. https://doi.org/10.3109/02844317409084386
  6. Moll KL, Huffman WC, Lierle DM, Smith JK. Factors related to the success of pharyngeal flap procedures. Plast Reconstr Surg 1963;32:581-8. https://doi.org/10.1097/00006534-196312000-00001
  7. Van Demark DR, Hardin MA. Longitudinal evaluation of articulation and velopharyngeal competence of patients with pharyngeal flaps. Cleft Palate J 1985;22:163-72.
  8. Kim JH, Bae YC, Hwang SM, Jeon JY. Simple method of speech evaluation in the Korean patient with cleft palate. J Korean Soc Plast Reconstr Surg 1999;26:858-65.
  9. Wong KWY, Klaiman PG, Forrest CR. Posterior pharyngeal flaps. In: Losee JE, Kirschner RE, editors. Comprehensive cleft care. New York: McGraw-Hill Medical; 2009. p. 649-64.
  10. Graham WP 3rd, Hamilton R, Randall P, Winchester R, Stool S. Complications following posterior pharyngeal flap surgery. Cleft Palate J 1973;10:176-80.
  11. Dailey SA, Karnell MP, Karnell LH, Canady JW. Comparison of resonance outcomes after pharyngeal flap and furlow double-opposing Z-plasty for surgical management of velopharyngeal incompetence. Cleft Palate Craniofac J 2006;43:38-43. https://doi.org/10.1597/04-118r.1
  12. Katzel EB, Shakir S, Naran S, MacIsaac Z, Camison L, Greives M, et al. Speech outcomes after clinically indicated posterior pharyngeal flap takedown. Ann Plast Surg 2016;77:420-4. https://doi.org/10.1097/SAP.0000000000000632
  13. Agarwal T, Sloan GM, Zajac D, Uhrich KS, Meadows W, Lewchalermwong JA. Speech benefits of posterior pharyngeal flap are preserved after surgical flap division for obstructive sleep apnea: experience with division of 12 flaps. J Craniofac Surg 2003;14:630-6. https://doi.org/10.1097/00001665-200309000-00006
  14. Sirois M, Caouette-Laberge L, Spier S, Larocque Y, Egerszegi EP. Sleep apnea following a pharyngeal flap: a feared complication. Plast Reconstr Surg 1994;93:943-7. https://doi.org/10.1097/00006534-199404001-00007
  15. Ysunza A, Garcia-Velasco M, Garcia-Garcia M, Haro R, Valencia M. Obstructive sleep apnea secondary to surgery for velopharyngeal insufficiency. Cleft Palate Craniofac J 1993;30:387-90. https://doi.org/10.1597/1545-1569_1993_030_0387_osasts_2.3.co_2
  16. Peat BG, Albery EH, Jones K, Pigott RW. Tailoring velopharyngeal surgery: the influence of etiology and type of operation. Plast Reconstr Surg 1994;93:948-53. https://doi.org/10.1097/00006534-199404001-00008
  17. Liao YF, Chuang ML, Chen PK, Chen NH, Yun C, Huang CS. Incidence and severity of obstructive sleep apnea following pharyngeal flap surgery in patients with cleft palate. Cleft Palate Craniofac J 2002;39:312-6. https://doi.org/10.1597/1545-1569_2002_039_0312_iasoos_2.0.co_2
  18. Meek MF, Coert JH, Hofer SO, Goorhuis-Brouwer SM, Nicolai JP. Short-term and long-term results of speech improvement after surgery for velopharyngeal insufficiency with pharyngeal flaps in patients younger and older than 6 years old: 10-year experience. Ann Plast Surg 2003;50:13-7. https://doi.org/10.1097/00000637-200301000-00003
  19. Dorf DS, Curtin JW. Early cleft palate repair and speech outcome. Plast Reconstr Surg 1982;70:74-81. https://doi.org/10.1097/00006534-198207000-00015

Cited by

  1. Use of a buccinator myomucosal flap and bilateral pedicled buccal fat pad transfer in wide palatal fistula repair: a case report vol.22, pp.4, 2021, https://doi.org/10.7181/acfs.2021.00269
  2. Potential role of artificial intelligence in craniofacial surgery vol.22, pp.5, 2021, https://doi.org/10.7181/acfs.2021.00507