Age-Related Analysis of Improvement Regression after Repair by Superiorly Pharyngeal Flap in Velopharyngeal Insufficiency Patients

Hassan, Medhat; Zein, Ahmed M.; Shooukr, Tarek; Tomoum, Mohamed; Sadaka, Mohamed

doi:10.21608/ejprs.2020.112461

Age-Related Analysis of Improvement Regression after Repair by Superiorly Pharyngeal Flap in Velopharyngeal Insufficiency Patients

Document Type : Original Article

Authors

¹ The Department of Plastic, Reconstructive & Burn Surgery, Faculty of Medicine, Menoufia University

² The Department of Otorhinolaryngology & Phonetics, Faculty of Medicine, Menoufia University

³ The Departmentof Plastic & Reconstructive Surgery, Faculty of Medicine,

⁴ The Department of Otolaryngology/Head & Neck Surgery, Faculty of Medicine, Tanta University

⁵ The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Tanta University

10.21608/ejprs.2020.112461

Abstract

Velopharyngeal insufficiency (VPI) has many signs that
usually affects social relations and mental health of patients
including hypernasality, misarticulating, and grimacing. The
most commonly used method has been the pharyngeal flap < br />method especially the superiorly based pharyngeal flap, due
its ability to solve former problems with high grades of
improvement. However, with long term follow-up, these high
grades of improvement showed regression. It has been reported
that these flaps tend to contract, resulting in narrowing and
tethering of the palate, and that the age factor has a rule in
this regression. The aim of this study is to evaluate the relation
between age of repair and the changes that happen in superior
pharyngeal flap after surgery leading to regression of the
improvement we have gained. In this cross-sectional study,
36 patients with velopharyngeal insufficiency who aged
between 3 and 15 were included in this study, the study was
performed at Department of plastic, reconstructive and burn
surgery, Menoufia University Hospital, Egypt. The hypernasality
degrees and misarticulating was measured by Menoufia
hospital speech therapists on the basis of special professional
parameters preoperatively, 3 months and 18 months after
superiorly based pharyngeal flap surgery was performed. This
was also associated with video recorded endoscopic investigations
to determine the shape and size of the flaps performed
and the postoperative lateral ports dimensions during each
follow-up. Following repair by superiorly based pharyngeal
flap, improvement in the variant degrees of hyper-nasality
was recorded among different age categories and statistical
analyses expressed loss of significant differences between the
responses of patients undergoing superiorly based pharyngeal
flap repair among different ages. But after 18 months, Ages
below 6 years showed regression in this improvement more
than ages above 6 years. Video recordings revealed that degree
of flap tubing was obvious in ages below 6 than those above
6 years. Results of this study suggest that most of patients
undergoing superiorly based pharyngeal flaps experience a
significant improvement of hyper-nasality and misarticulating.
But after 18 months, regression in this improvement is noticed
especially in ages below 6 years due to flap tubing unless
certain precautions are followed to decrease this regression.

Keywords

Main Subjects

Congenital anomalies

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