Using the superiorly based pharyngeal flap to surgically manage cleft velopharyngeal insufficiency: a cohort study

Introduction: The surgical management of velopharyngeal insufficiency is traditionally guided by algorithms based on dynamic imaging, such as nasoendoscopy and video fluoroscopy. In practice, however, surgeons often favour a single surgical technique in all patients—irrespective of observed velopharyngeal closure pattern. In this study, we examine the utility of the superiorly based pharyngeal flap for correcting velopharyngeal insufficiency in a cohort of patients with varied velopharyngeal closure patterns. Methods: A retrospective cohort study was conducted of velopharyngeal insufficiency patients treated by a single surgeon at the Royal Children’s Hospital, Melbourne, between 2008 and 2015. Prior to surgery, patients underwent speech evaluation as well as nasopharyngoscopy for assessment of velopharyngeal closure pattern. Irrespective of the closure pattern observed, patients were treated using a superiorly based pharyngeal flap. Following surgery, serial evaluations for residual velopharyngeal insufficiency and surgical complications were performed. Results: A total of 18 cleft palate patients met the criteria for study inclusion. Preoperative speech evaluation revealed mild velopharyngeal insufficiency in one patient (5.6%), moderate velopharyngeal insufficiency in nine patients (50%), and severe velopharyngeal insufficiency in eight patients (44.4%). Repeat speech evaluation one year after surgery demonstrated correction of velopharyngeal insufficiency in 17 patients, representing a 94.4 per cent success rate. Furthermore, only two patients experienced postoperative snoring (11.1%). Conclusion: Consideration of velopharyngeal closure pattern is not required for effective surgical management of velopharyngeal insufficiency.