Outcomes of sphincter pharyngoplasty and palatal lengthening for velopharyngeal insufficiency: a 10-year experience.

OBJECTIVE: To report our experience in the care of patients treated for velopharyngeal insufficiency (VPI) with sphincter pharyngoplasty (SP) with or without the addition of palatal lengthening by Furlow palatoplasty (FP).

DESIGN: Retrospective analysis.

SETTING: Tertiary care cleft palate and craniofacial clinic.

PATIENTS: Forty-six children with VPI, most of whom had palatal clefts, treated with SP (1998-2008).

INTERVENTIONS: Treatment consisted of SP alone (n = 20) or SP plus FP (n = 26).

MAIN OUTCOME MEASURE: Rate of revision surgery, indicating persistent VPI after surgical treatment.

RESULTS: Of 46 patients, 6 (13%) required surgical revision. Regarding need for revision, no statistically significant differences were found concerning age, sex, cleft type, syndrome, or time between palate repair and SP. Indications for revision included persistent hypernasality (n = 2), inferior position (n = 2), flap dehiscence (n = 1), and obstructed sleep (n = 1). Postoperative improvement in velopharyngeal competence was documented in all revision cases. No patients required a second revision. Twenty-six of 46 patients (57%) underwent FP in addition to SP. The remaining 20 patients (43%) had SP alone. The revision rate was 4% (n = 1) for the SP plus FP group and 25% (n = 5) for the SP alone group (P = .04).

CONCLUSIONS: Sphincter pharyngoplasty is an effective procedure for the management of VPI, with a success rate of 87% when using need for surgical revision as the primary outcome measure. This number improved to 100% after a single revision, with elimination of VPI in all revision cases. Concomitant FP and SP may improve outcomes compared with SP alone. Further prospective studies are needed to elucidate this relationship.