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Pharyngoplasty as a Primary Intervention in Patients with Velopharyngeal Incompetence
Vidya Shankaran,M.D.
James A. Lehman, M.D.
Summa Health System, Akron OH
2012-02-14
Presenter: Vidya Shankaran ,M.D.
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. Please make a statement as to how much of the above work represents the original work of the resident.
Director Name: Douglas Wagner, M.D.
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
This presentation evaluates a rather large series of pediatric patients undergoing pharyngoplasty. It addresses the clinical decision making and pre-operative work-up for patients with velopharyngeal incompetence as well as the available modes of correction (both surgical and non-surgical). Surgical complications of this large patient series will be discussed. Long-term post-operative care requirements will also be addressed.
How will your presentation be used by practicing physicians in the audience?
Pharyngoplasty may not be considered a primary method of surgical correction for velopharyngeal incompetence for some practioners. Moreover, the reasons to perform this surgery over other corrective surgeries may not be clear. This presentation will outline surgical decision-making and enhance practioners' knowledge of this valuable procedure.
Objectives
Pharyngoplasty is most commonly performed for persistent velopharyngeal incompetence (VPI) following cleft palate surgery. The goal of this study was to demonstrate that while pharyngoplasty is a valuable adjunct to cleft palate repair in patients with residual VPI, it also serves as a viable primary intervention in patients with noncleft or submucous cleft VPI.
Methods
A retrospective review of pharyngoplasties performed by a single surgeon at a tertiary care children's hospital between 2008 and 2011 was completed. Preoperative studies were reviewed to identify key findings suggestive of success in resolving VPI.
Results
69 pharyngoplasties were performed between 2008 and 2011.Of these patients, nine (13%) had no underlying palatal pathology and ten (14%) with submucous cleft had not undergone previous surgical intervention involving the palate. Six of these patients had undergone prior tonsillectomy and/or adenoidectomy. Prior to surgery, patients underwent either nasopharyngoscopy or fluoroscopic evaluation to evaluate velar function. All studies demonstrated the presence of palatal movement with incomplete or inadequate velopharyngeal contact. None of these studies demonstrated absent palatal movement. All patients underwent successful pharngoplasty.
Conclusions
Pharyngoplasty is an important, corrective surgery for VPI in many groups of patients, including those without previous palatal surgery. Preoperative studies are recommended in this group of patients to ensure that a degree of palatal movement is present prior to this intervention. In combination with rigorous speech therapy, pharyngoplasty may serve as a valuable primary intervention in this select group of patients.
