Results with sphincter pharyngoplasty and pharyngeal flap

Objective: To evaluate speech outcomes and complications of sphincter phary ngoplasty and pharyngeal flap performed for management of velopharyngeal in sufficiency (VPI). Design: Case series. Setting: Tertiary care children's h ospital. Patients: All patients who underwent pharyngeal flap or sphincter pharyngoplasty from :1990 to 1995. Methods. Perceptual speech analysis was used to assess severity of VPI, presence of nasal air emissions and quality of nasal resonance (hyper, hypo, or normal). Pre-operative measures of vel opharyngeal function were based upon nasendoscopy- and videofluoroscopic sp eech assessment. Recommendations for management were made by the attending surgeon. Complications of hyponasality and obstructive sleep symptoms (OSS) were noted. Patient characteristics were compared using univariate analysi s. Results: Sixteen patients underwent sphincter pharyngoplasty and 18 pati ents underwent superiorly based pharyngeal flap. Patients were similar in t erms of lateral pharyngeal wall medial motion and palatal elevation. The gr oups were also similar with regard to VPI severity, though there was a tren d for more severe VPI in patients undergoing sphincter pharyngoplasty than pharyngeal flap (50 vs. 33.3%, respectively). Patients with pharyngoplasty had a higher rate of resolution of VPI than those who had pharyngeal flap ( 50 vs. 22.2%, respectively), although this was not statistically significan t. Post operative hyponasality and obstructive sleep symptoms were present in both groups. However, only patients who underwent PF and had postoperati ve OSS had obstructive sleep apnea (OSA). Conclusions: There were no detect able anatomic differences between treatment groups implying that treatment selection during the study period was not guided by strict anatomic criteri a. Sphincter pharyngoplasty may have a higher success rate with a lower ris k of OSS. (C) 1999 Published by Elsevier Science Ireland Ltd. All rights re served.