Adaptation of pharyngeal wall adduction after pharyngeal flap surgery

Objective: The purpose of this investigation was to study lateral pharyngea l wall adduction relative to pharyngeal flaps of different widths. The hypo thesis to be tested was that pharyngeal wall adduction does not increase po stoperatively but may decrease due to the mechanical hindrance of a wide fl ap. Design: In this prospective study, adaptation of lateral pharyngeal wall ad duction during speech was studied relative to pharyngeal flaps of different widths utilizing videoradiography, Flap width was determined nasopharyngos copically, Setting: All patients were treated by the Stockholm Cleft Palate Team, Swed en, Patients: Fifty-three patients were strictly selected by discarding conditi ons known to exert uncontrolled influence on velopharyngeal sphincter funct ion. Results: The results revealed a potential for adaptation of pharyngeal wall adduction to different flap widths, The magnitude and character (increase or decrease) of change in adduction was significantly correlated with the d egree of preoperative adduction and with the width of the flap. In patients with limited preoperative adduction, pharyngeal wall activity increased, m ore in the presence of a narrow flap while less if the flap was wide. When preoperative adduction was pronounced, the postoperative activity decreased because of mechanical hindrance by the flap, and the degree of impediment was correlated to the width of the flap. Conclusion: A potential for increased lateral pharyngeal wall adduction aft er pharyngeal flap surgery was verified, but the result cannot be interpret ed as generally applicable because of the strict selection of patients.