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Pharyngeal flap surgery in properly selected patients improves speech

When patients were selected appropriately, pharyngeal flap surgery was effective in improving speech, with a revision rate of 20%, according to researchers.

In a retrospective review of medical records, researchers identified 61 patients with velopharyngeal insufficiency who underwent a superiorly based pharyngeal flap surgery from June 2008 through January 2013. Twenty-four of the patients were male, and mean patient age was 8.2 years.

Using nasal air emission (NAE) and resonance scores, the researchers compared perceptual speech patterns from before and after surgery. Additionally, multivariable mixed-effects logistic regression was used to evaluate the association between the need for revision surgery and the presence of certain covariates.

Fifty-one patients underwent an orofacial cleft and previous palatoplasty, and 10 patients had velopharanyngeal insufficiency of a non-cleft origin. Hard palate complete clefts were the most commonly observed, occurring in 16 patients (26%), followed by partial clefts of the hard palate in 15 patients (25%), bilateral complete cleft lip and palate in eight patients (13%), submucous cleft palate in six patients (10%), soft palate clefts in four patients (7%) and cleft of the uvula in two patients (3%).

NAE and resonance scores were rated as three or higher (moderate-to-severe) in 16 (43%) of 37 patients and 19 (51%) of 37 patients, respectively. The NAE and resonance scores decreased significantly after surgery, according to the researchers, with the mean NAE score decreasing from 2 preoperatively to 0.8 postoperatively and the mean resonance score of 2.4 preoperatively decreasing to 0.9 postoperatively.

According to the researchers, patient age was found to be the only covariate with a significant association to revision rate. Higher patient age was associated with a higher likelihood that revision surgery would be necessary. - by Abigail Sutton

Disclosures: The researchers report no relevant financial disclosures.