Outcomes of sphincter pharyngoplasty and palatal lengthening for velopharyngeal insufficiency: a 10-year experience.

OBJECTIVE

To report our experience in the care of patients treated for velopharyngeal insufficiency (VPI) with sphincter pharyngoplasty (SP) with or without the addition of palatal lengthening by Furlow palatoplasty (FP).

DESIGN

Retrospective analysis.

SETTING

Tertiary care cleft palate and craniofacial clinic.

PATIENTS

Forty-six children with VPI, most of whom had palatal clefts, treated with SP (1998-2008).

INTERVENTIONS

Treatment consisted of SP alone (n = 20) or SP plus FP (n = 26).

MAIN OUTCOME MEASURE

Rate of revision surgery, indicating persistent VPI after surgical treatment.

RESULTS

Of 46 patients, 6 (13%) required surgical revision. Regarding need for revision, no statistically significant differences were found concerning age, sex, cleft type, syndrome, or time between palate repair and SP. Indications for revision included persistent hypernasality (n = 2), inferior position (n = 2), flap dehiscence (n = 1), and obstructed sleep (n = 1). Postoperative improvement in velopharyngeal competence was documented in all revision cases. No patients required a second revision. Twenty-six of 46 patients (57%) underwent FP in addition to SP. The remaining 20 patients (43%) had SP alone. The revision rate was 4% (n = 1) for the SP plus FP group and 25% (n = 5) for the SP alone group (P = .04).

CONCLUSIONS

Sphincter pharyngoplasty is an effective procedure for the management of VPI, with a success rate of 87% when using need for surgical revision as the primary outcome measure. This number improved to 100% after a single revision, with elimination of VPI in all revision cases. Concomitant FP and SP may improve outcomes compared with SP alone. Further prospective studies are needed to elucidate this relationship.