Comparison between pharyngeal flap surgery and sphincteroplasty: nasometric and aerodynamic analysis

PURPOSE:

to compare the effect of pharyngeal flap surgery and sphincteroplasty on hypernasality and velopharyngeal closure in velopharyngeal insufficiency management, by means of instrumental assessment.

METHODS:

thirty patients with repaired cleft palate±lip, submitted to surgical treatment for velopharyngeal insufficiency (15 pharyngeal flap and 15 sphincteroplasty) were evaluated before and, at least, 1 year after surgery. Hypernasality was estimated by means of nasalance scores (acoustic correlate of nasality) obtained by nasometry considering a cutoff score of 27%. Velopharyngeal closure was determined by the velopharyngeal area measurement. Nasalance scores were obtained by nasometry, during the reading of a set of 5 sentences containing exclusively oral sounds, considering the cutoff value of 27%. Velopharyngeal area was provided by the measurement of velopharyngeal area by means of pressure-flow technique and was classified as: 0 to 4.9 mm²=adequate; 5 to 19.9 mm²=borderline and ≥20mm² inadequate. Differences between the two techniques were accepted as significant when p < 0.05.

RESULTS:

before surgery. nasalance mean scores were 43±8.4% and 45±14.2% and velopharyngeal area mean were 51±35.4mm² and 69±29.2mm² for the pharyngeal flap and sphincteroplasty groups, respectively. After surgery, nasalance mean scores were 27±10.1% and 31±14.2% and velopharyngeal area mean were 3.6±5.5mm² and 24±32.7mm² for the pharyngeal flap and sphincteroplasty groups, respectively. The reduction of the nasalance scores and velopharyngeal area was statistically significant in both groups.

CONCLUSION:

these results suggest that pharyngeal flap demonstrated to be more efficient than sphincteroplasty in the elimination of hypernasality and adequacy of velopharyngeal closure in the patients studied.

Cleft Palate; Velopharyngeal Insufficiency; Rhinomanometry