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Ann Plast Surg 2022 05;88(3 Suppl 3):S152-S155

From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.

Introduction: Velopharyngeal insufficiency (VPI), a stigmatizing hallmark of palatal dysfunction, occurs in a wide spectrum of pediatric craniofacial conditions. The mainstays for surgical correction include palate repair and/or pharyngeal surgery. However, primary pharyngoplasty has a failure rate of 15% to 20%. Read More

J Craniofac Surg 2019 Mar/Apr;30(2):e175-e178

Division of Plastic and Reconstructive Surgery, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH.

Background: Proper evaluation and analysis of speech surgery outcomes for cleft-related velopharyngeal incompetence in children and young adults performed on humanitarian missions is poorly characterized. The aim of this study is to examine the effect of using a multidisciplinary team on cleft-related humanitarian missions. The effect on patient selection, velopharyngeal mechanism imaging, and speech outcomes after surgery will be highlighted. Read More

J Craniofac Surg 2017 Oct;28(7):e616-e617

Cranioplast, Plastic, and Craniofacial Surgery Clinic, Istanbul, Turkey.

Cleft palate is one of the challenging problems in the field of craniofacial surgery. In particular, the conventional methods of bilateral and severe cleft palate repairs have failed to achieve normal speech. In most instances, secondary procedures such as pharyngoplasty and pharyngeal flap surgery are performed to improve speech. Read More

Cleft Palate Craniofac J 2016 11 11;53(6):629-633. Epub 2016 Jan 11.

Objective: To compare facial growth characteristics in patients with cleft palate who have undergone pharyngeal flap with those who had palatal lengthening or pharyngoplasty and to control subjects who have not had surgery for velopharyngeal insufficiency (VPI).

Design: Matched retrospective cohort study.

Setting: Multidisciplinary cleft care center. Read More

J Craniofac Surg 2009 Sep;20 Suppl 2:1934-8

Craniofacial Center, Department of Oral and Maxillofacial Surgery, Shanghai 9th People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: Speech disorders are the most common presentations of patients with velocardiofacial syndrome (VCFS) and are difficult to be treated with very good treatment outcome. The purpose of this study was to evaluate the clinical diagnosis and outcomes of sequential treatment of therapy for VCFS.

Methods: A retrospective study of 120 patients (ages ranged from 4. Read More

Int J Pediatr Otorhinolaryngol 2008 Feb 26;72(2):173-7. Epub 2007 Nov 26.

Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt.

Objective: (a) Pharyngeal flap and sphincter pharyngoplasty are the procedures most frequently chosen by craniofacial surgeons for surgical management of velopharyngeal insufficiency. Both operations may be complicated by obstructive breathing and even sleep apnea. (b) The purpose of this study is to evaluate the efficacy of a palatopharyngeal sling in the treatment of velopharyngeal insufficiency in cases with weak palatal mobility and its effect on breathing. Read More

B-ENT 2006 ;2 Suppl 4:85-94

Childhood Communication Center, University of Washington, Childrens Hospital and Regional Medical Center, Seattle, WA 98105, USA.

Velopharyngeal insufficiency is the main morbidity associated with clefting of the secondary palate. Therefore, it is important to monitor speech production in all children with a history of cleft palate. Diagnosis and management of velopharyngeal insufficiency is an important function of the cleft palate team. Read More

Otolaryngol Head Neck Surg 2003 Oct;129(4):321-6

Otolaryngology Department PFP 21201, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, USA.

Objective: We sought to assess complication rates and speech outcomes in patients undergoing pharyngeal flap surgery. Study design and setting We conducted a retrospective chart and database review at a tertiary craniofacial center.

Patients: Eighty-seven patients were identified as having pharyngeal flaps between January 1990 and December 2000. Read More

Cleft Palate Craniofac J 1998 Sep;35(5):447-53

Cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital, Washington University School of Medicine, Missouri 63110, USA.

Objective: This paper reports on the rates of failure of operations (pharyngeal flap and sphincter pharyngoplasty) performed for management of velopharyngeal dysfunction, and outcome following their revision.

Design: Anatomic abnormalities associated with unacceptable vocal resonance and nasal air escape following pharyngeal flap and sphincter pharyngoplasty were critiqued. The results of primary pharyngeal flap were evaluated for 65 patients, and the results of primary sphincter pharyngoplasty were evaluated for 123 patients. Read More

Plast Reconstr Surg 1998 Apr;101(5):1184-95; discussion 1196-9

Department of Surgery, Plastic and Reconstructive, St. Louis Children's Hospital, Washington University School of Medicine, MO 63110, USA.

The purpose of this two-part study was to evaluate the safety of surgical management of speech production disorders in patients with velocardiofacial syndrome without preoperative cervical vascular imaging studies. Anomalous internal carotid arteries have been shown to be a frequent feature of velocardiofacial syndrome. These vessels pose a potential risk for hemorrhage during velopharyngeal narrowing procedures. Read More

Plast Reconstr Surg 1997 Apr;99(4):1151-3

Institute for Craniofacial and Reconstructive Surgery, Southfield, Mich., USA.

Uvulopalatopharyngoplasty is a surgical procedure that has a role in the management of obstructive sleep apnea and chronic snoring. A recognized complication of the procedure is postoperative velopharyngeal insufficiency. In this paper, three patients who have required corrective surgery for this problem are presented, and their management is discussed. Read More

Plast Reconstr Surg 1996 Dec;98(7):1182-90

Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada.

The association of medially positioned internal carotid arteries and velocardiofacial (Shprintzen) syndrome was first made in 1987. This is also the most common syndrome associated with facial clefting. The potentially dangerous implications in children with this syndrome requiring pharyngoplasty for velopharyngeal incompetence and stigmatized hypernasal speech involve potential damage to these vessels. Read More

Cleft Palate Craniofac J 1996 May;33(3):183-9

Department of Surgery, Plastic and Reconstructive, Washington University School of Medicine, St. Louis, Missouri, USA.

This report describes postoperative airway compromise following sphincter pharyngoplasty (SP) for treatment of post-palatoplasty velopharyngeal dysfunction. A retrospective review of 58 SPs performed for post-palatoplasty velopharyngeal dysfunction, on 30 male, and 28 female patients, over a 5-year study period was undertaken at a tertiary referral academic institution (Washington University School of Medicine), at the St. Louis Children's Hospital, Cleft Palate and Craniofacial Deformities Institute. Read More

Plast Reconstr Surg 1995 Jul;96(1):129-38

Division of Plastic Surgery, Cleft Palate and Craniofacial Deformities Institute of St. Louis Children's Hospital, Mo., USA.

This paper reports results of surgical management of failed sphincter pharyngoplasties that were performed for velopharyngeal dysfunction. Revisional surgery consisted of tightening of the sphincter pharyngoplasty port or reinsertion of sphincter pharyngoplasty flaps following dehiscence. We critique the anatomic abnormalities associated with unacceptable vocal resonance and nasal air escape following sphincter pharyngoplasty and analyze the effect of sphincter pharyngoplasty revision on ultimate speech outcome. Read More