Table of Contents
ISRN Otolaryngology
Volume 2012 (2012), Article ID 181202, 10 pages
http://dx.doi.org/10.5402/2012/181202
Clinical Study

Results and Complications of 1104 Surgeries for Velopharyngeal Insufficiency

St. John’s Hospital, Division of Pediatric Otorhinolaryngology, 1125 Budapest, Diós árok 1-3, Hungary

Received 12 December 2011; Accepted 18 January 2012

Academic Editors: S. L. Halum and M. P. Robb

Copyright © 2012 Jenő Hirschberg. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Velopharyngeal insufficiency (VPI) means that the velopharyngeal closure is inadequate or disturbed. VPI may be organic or functional, congenital or acquired and is caused by structural alterations or paresis. The symptoms are primarily to be found in speech (hypernasality), more rarely in swallowing and hearing. The management types are as follows: speech therapy, surgery, speech bulb, and others. Surgery is indicated if the symptoms of VPI cannot be improved by speech therapy. Among the operative methods, velopharyngoplasty constitutes the basis of the surgery. The pharyngeal flap was incorporated and survived in 98.1% of the cases, hyperrhinophony disappeared or became minimal in 90% after surgery in our material (1104 cases). The speech results seemed to be the same with superiorly or inferiorly based pharyngeal flap. The Furlow technique, push-back procedure, the sphincteroplasty, and the augmentation were indicated by us if the VP gap was less than 7 mm; these methods may also be used as secondary operation. We observed among 1104 various surgeries severe hemorrhage in 5 cases, aspiration in 2 cases, significant nasal obstruction in 68 patients, OSAS in 5 cases; tracheotomy was necessary in 2 cases. Although the complication rate is rare, it must always be considered that this is not a life-saving but a speech-correcting operation. A tailor-made superiorly based pharyngeal flap is suggested today, possibly in the age of 5 years.