Comparison between two types of pharyngeal flap with regard to configuration at rest and function and speech outcome

Objective: In management of hypernasality, wide pharyngeal flaps have been advocated when pharyngeal wall adduction is limited, Pharyngeal flaps merge d into a transversely split velum (TS flaps) are reported to be wider than if the velum is split in the midline (MS flaps). The hypothesis to be teste d was that TS flaps are wider than MS flaps and are more caudally based. Design: In this prospective study, MS flaps were videoradiographically and nasopharyngoscopically compared with TS flaps at both rest and function. Ph aryngoplasty was randomly performed by one of three surgeons and the radiog raphic examinations were carried out by one radiologist, The speech was ass essed pre- and postoperatively, Setting: The Stockholm Cleft Palate Team, Sweden, treated all patients. Patients: After strict selection of the patients to avoid any uncontrolled impact on velopharyngeal sphincter function, 22 patients with limited phary ngeal adduction received TS flaps and 20 patients with good adduction recei ved MS flaps. Results: The data failed to show any difference in location of flap base an d in:flap width at rest. During function, TS flaps demonstrated statistical ly significant widening of the flap base. TS flaps, but not MS flaps, often had a bulge that appeared to assist velopharyngeal closure in some patient s. Speech evaluation revealed that both flap types corrected velopharyngeal insufficiency equally well. Conclusions: TS flaps were not wider than MS flaps, and functional plastici ty of the TS flap appeared essential for elimination of velopharyngeal insu fficiency, Contribution of postoperative adaptation of the pharyngeal wall adduction remains to be clarified.