This work was done at the Otolaryngology–Head and Neck Surgery Department, Zagazig University Hospitals, Zagazig, Egypt.
Facial Plastics/Reconstructive Surgery
Version of Record online: 17 JAN 2012
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 2, pages 260–265, February 2012
How to Cite
Emara, T. A. and Quriba, A. S. (2012), Posterior pharyngeal flap for velopharyngeal insufficiency patients: A New Technique for Flap Inset. The Laryngoscope, 122: 260–265. doi: 10.1002/lary.22456
The authors have no funding, financial relationships, or conflicts of interest to disclose.
- Issue online: 23 JAN 2012
- Version of Record online: 17 JAN 2012
- Manuscript Accepted: 24 OCT 2011
- Manuscript Revised: 20 OCT 2011
- Manuscript Received: 15 SEP 2011
- Pharyngeal flap;
- transverse palatal incision;
- velopharyngeal insufficiency;
- Level of Evidence: 2b
To describe a modification of the originally described superiorly based pharyngeal flap as a secondary operation to correct velopharyngeal insufficiency (VPI) in patients with nonsyndromic repaired cleft palate.
Prospective clinical trial at university medical center.
Twenty-six patients with VPI after cleft palate repair underwent a modified posterior pharyngeal flap procedure. Patients with submucous cleft palate or associated with syndromic VPI or Pierre Robin sequence were excluded from the study. Flap was harvested high up in the nasopharynx and inserted into the soft palate through a transverse full-thickness palatal incision. Lateral pharyngeal ports were determined by 45-degree nasoendoscopy. Speech assessment was done preoperatively and 3 months postoperatively. The flap integrity and lateral pharyngeal ports were evaluated with postoperative nasoendoscopy.
Postoperative speech assessment showed significant improvement in the overall velopharyngeal function, nasal emission, resonance, and articulation defects. The pattern of velopharyngeal closure was circular in 15 patients, coronal in six patients, and sagittal in five patients. Eighteen patients received medium to wide flap, five patients had narrow flap, and three patients had near obstructing flap. Velopharyngeal function was normal or borderline insufficiency in 24 patients (92%). Partial flap dehiscence was seen in two patients and was considered as failure despite the significant improvement in their preoperative VPI.
The minimal complication and ease of flap design with precise flap inset make this modified superior flap technique easily applicable with a high success rate for patients with VPI after cleft palate repair.