Outcomes of Combined Furlow Palatoplasty and Sphincter Pharyngoplasty for Velopharyngeal Insufficiency

Abstract

Objectives: Compare surgical outcomes between pharyngeal flap, sphincter pharyngoplasty, and concomitant Furlow palatoplasty and sphincter pharyngoplasty in the management of pediatric velopharyngeal insufficiency. Methods: Retrospective review of 96 patients with velopharyngeal insufficiency, who underwent surgical intervention at a tertiary pediatric care center between 2008 and 2012. Patients with velocardiofacial syndrome were excluded from the study. Surgical interventions were categorized as pharyngeal flap, sphincter pharyngoplasty, and concomitant Furlow palatoplasty and sphincter pharyngoplasty. Main outcome measures included perceptual speech analyses, complications, and surgical revision rates. Results: Of the 96 reviewed patients, 38 (39.6%) underwent pharyngeal flap, 20 (20.8%) sphincter pharyngoplasty, and 38 (39.6%) concomitant Furlow palatoplasty and sphincter pharyngoplasty. The mean improvement in postoperative perceptual speech analysis scores was significantly higher in both the combined procedure and pharyngeal flap when compared to sphincter pharyngoplasty alone ( P = .013, P = .031). No statistically significant difference in speech improvement was observed between the combined procedure and pharyngeal flap. There were no differences in complications among the three surgical interventions. However, the combined procedure required significantly less surgical revisions than the pharyngeal flap ( P = .019). Conclusions: Concomitant Furlow palatoplasty and sphincter pharyngoplasty is an effective procedure for the management of pediatric velopharyngeal insufficiency and may result in superior speech outcomes and lower revision rates than sphincter pharyngoplasty and pharyngeal flap, respectively.