Pharyngoplasty versus buccinator myomucosal flap in the management of velopharyngeal-insufficiency coronal pattern of closure

Abstract

Background Velopharyngeal insufficiency (VPI) is an anatomical or structural defect that hinders sufficient velopharyngeal closure, as visualized on nasoendoscopy. Aim The aim of this work was to compare the result of sphincter pharygoplasty versus buccinator myomucosal flap in management of VPI cases with coronal pattern of closure in order to select the proper operation for managing these cases. Patients and methods This study included 20 patients in our institute with residual VPI after primary repair of cleft palate with age range between 3 and 12 years. Randomly, patients with coronal pattern of closure were categorized into two groups: (A) 10 patients underwent sphincteroplasty and (B) 10 patients underwent buccinator myomucosal flap. Preoperatively and 2 months after operation, every patient was evaluated by auditory perceptual assessment, flexible nasopharyngoscopy, and nasometry. The results were documented, tabulated, and statistically analyzed. Results There were statistically significant improvements of auditory perceptual assessment in obligatory speech disorders and intelligibility of speech, nasometeric evaluation in oral and nasal sentences in both groups. Additionally, there were significant improvements of nasoendoscopic evaluations in the degree of velar movement, presence or absence and size of persistent gap in both groups, and in the degree of lateral pharyngeal wall movements in group A. Conclusion Sphincterpharyngoplasty or buccinator myomucosal flap have satisfactory results in treatment of VPI patients with coronal pattern of closure with no statistically significant difference between both groups.