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ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 2  |  Page : 484-489

Superiorly based pharyngeal flap versus endoscopic augmentation of the posterior pharyngeal wall, using cartilage graft in the treatment of velopharyngeal insufficiency


Department of Otorhinolaryngology, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Correspondence Address:
Ashraf A El-Demerdash
MSc, Department of Otorhinolaryngology, Faculty of Medicine, Menoufia University, Shibein El-Kom, Menoufia 32511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.141733

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Objectives The aim of this study was to compare the functional outcome of the superiorly based pharyngeal flap and endoscopic augmentation pharyngoplasty, using cartilage graft in patients with velopharyngeal insufficiency (VPI). Background Surgical alteration of the velopharyngeal sphincter is directed at decreasing the horizontal cross-sectional surface area of the sphincter's tissue boundaries that can be achieved by different surgical operations with different outcomes. Materials and methods A total of 30 patients with VPI were enrolled into our study from July 2010 to March 2012. Patients were assessed by preoperative flexible fibro-optic nasopharyngoscopy and tape recording at phoniatrics clinic. Patients were classified into two groups: group I consisted of 12 patients for augmentation pharyngoplasty, and group II consisted of 18 patients for superiorly based pharyngeal flap. Each group was divided into two categories: (A) With good palatal movement and small central gap (B) With poor palatal movement and large central gap. Tape recording was repeated after phonotherapy (3-4 months postoperatively), and hypernasality was assessed using a five-degree rating scale, in which 0 = normal nasality and 4 = severe hypernasality. Complications were documented and statistical comparisons were made between subgroups IA and IIA and subgroups IB and IIB. Results We had four subgroups: IA that included seven patients, IB that included five patients, IIA that included 10 patients, and IIB that included eight patients. Subgroup IIA had a mean hypernasality score of 0.4 ± 0.8 SD, which was better than the mean score of 1.6 ± 0.5 SD in subgroup IA. Subgroup IIB had a mean hypernasality score of 0.8 ± 1.1 SD, which was significantly better than the mean score of 1.2 ± 0.8 SD in subgroup IB (P = 0.04). The complications were not significantly different between the two groups, and were all relatively mild. Conclusion Superiorly based pharyngeal flap proved to be better than augmentation pharyngoplasty in the management of hypernasality because of VPI, with significant difference in patients with poor palatal movement and a large central retropalatal gap. Both the techniques had accepted incidence of complications with no significant intergroup difference.


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