Does preexisting posterior pharyngeal wall motion drive the dynamism of sphincter pharyngoplasty?

Lateral speech videofluoroscopic evaluations were videotaped preoperatively and postoperatively for 20 patients who underwent sphincter pharyngoplasty. Randomized videotapes were constructed and subsequently evaluated by speech/language pathologists experienced in assessing patients with velopharyngeal dysfunction. Rating forms assessing various motion parameters of the posterior pharyngeal wall were completed and analyzed statistically. Results showed that the posterior pharyngeal wall configuration postoperatively was less likely to be rated as smooth relative to the preoperative configuration (p = 0.019). No other statistically significant data were obtained, although there was a trend for posterior pharyngeal wall movement rated as discrete preoperatively to be described as generalized postoperatively. We conclude that when comparing preoperative and postoperative parameters, sphincter pharyngoplasty does not significantly affect posterior pharyngeal wall motion. Posterior pharyngeal wall configuration is less likely to be categorized as smooth after sphincter pharyngoplasty relative to the preoperative condition. Although sphincter pharyngoplasty has been shown to improve velopharyngeal function, there is little evidence from this study to suggest that preexisting posterior pharyngeal wall motion causes sphincteric movement.