A. D. Chen1, B. N. Tran1, Q. Z. Ruan1, B. T. Lee1, O. Ganor2 1Beth Israel Deaconess Medical Center,Plastic And Reconstructive Surgery,Boston, MA, USA 2Boston’s Children Hospital,Plastic And Reconstructive Surgery,Boston, MA, USA
Introduction: Velopharyngeal insufficiency (VPI) often manifests after cleft repair or adenoidectomy as a result of an occult palatal problem, which can result in hypernasal speech and nasal air emission. This study aims to study the outcomes of different techniques for VPI correction using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).
Methods: VPI cases from 2012-2015 were identified. Patients were subdivided in 4 unique cohorts: (1) palatoplasty, (2) pharyngeal flap and sphincter pharyngoplasty, (3) lengthening, and (4) others including tissue excision and rearrangement, dermal grafts or fillers. Group characteristics and postoperative outcomes were compared using chi-square test for categorical variables and one-way ANOVA for continuous variables.
Results: There were 591 VPI cases identified, 83 in group1, 359 in group 2, 40 in group 3, and 109 in group 4. The average age of repair was 7.9 with palatoplasty and pharyngeal flap done at a later time. More Asian patients received lengthening compared to other techniques. The longest operating time (108 minutes) was noted in lengthening group while the longest length of stay (2 days) was seen in the palatoplasty group. Pediatric plastics performed the majority of the palatoplasty and lengthening cases whereas pediatric ENT performed most of the pharyngeal flap and local tissue rearrangement. Overall complication rate was 2%, with palatoplasty group had the lowest rate. Subgroup analysis comparing flap and sphincter techniques showed more complications in the pharyngeal flap group, however, these trends were not statistically significant.
Conclusion: Repairing a VPI can be done safely and effectively using different surgical approaches depending on the extent of the defect. A small gap causing a mild VPI will probably require a secondary palatoplasty, local tissue rearrangement or lengthening while a wide gap mandates bringing extra tissue to narrow it. Timely correction is crucial to facilitate proper phonation in children of developmental age.
