Clinical efficacy of Hogan posterior pharyngeal flap in repairing velopharyngeal insufficiency secondary to cleft palate in older patients

doi:10.7518/hxkq.2023.2023155

Abstract

Abstract:

Objective The clinical effects and surgical procedures of Hogan posterior pharyngeal flap in the treatment of the older patients with velopharyngeal insufficiency (VPI) after cleft palate repair were investigated. Methods A total of 33 patients (aged 10-35 years; average of 20.4 years) with VPI secondary to cleft palate were included. They underwent Hogan posterior pharyngeal flap to improve velopharyngeal closure function. The clinical efficacy of the ope-ration was evaluated with Chinese speech clarity measurement and nasopharyngeal fiberscope (NPF), and the velopharyngeal closure was graded. The average follow-up time was 13.3 months. Results The wounds of all patients were healed by first intention, and speech assessment showed that the consonant articulation increased and the rate of hypernasality and nasal emission decreased significantly (P<0.05). NPF examination showed that the postoperative velopharyngeal closure function significantly improved, 30 cases (91%) were gradeⅠ, and 3 cases (9%) were grade Ⅱ. Conclusion Hogan posterior pharyngeal flap for VPI secondary to cleft palate can significantly improve velopharyngeal closure.

Key words: velopharyngeal insufficiency, Hogan posterior pharyngeal flap, speech intelligibility, older patient, nasopharyngeal fiberscope

CLC Number:

R 782.2⁺2

Dong Zhe, Xie Ying, Yang Jiegang, Fu Yuchuan, Li Jian.. Clinical efficacy of Hogan posterior pharyngeal flap in repairing velopharyngeal insufficiency secondary to cleft palate in older patients[J]. West China Journal of Stomatology, 2023, 41(6): 713-718.

Figures/Tables 6

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References 27

1	Losee J, Kirschner R. Comprehensive cleft care: volume two[M]. New York: Thieme Medical Publishers, 2015.
2	Meek MF, Coert JH, Hofer SO, et al. Short-term and long-term results of speech improvement after surgery for velopharyngeal insufficiency with pharyngeal flaps in patients younger and older than 6 years old: 10-year experience[J]. Ann Plast Surg, 2003, 50(1): 13-17.
3	Perry JL, Kotlarek KJ, Sutton BP, et al. Variations in velopharyngeal structure in adults with repaired cleft palate[J]. Cleft Palate Craniofac J, 2018, 55(10): 1409-1418.
4	Mason KN, Perry JL, Riski JE, et al. Age-related chan-ges between the level of velopharyngeal closure and the cervical spine[J]. J Craniofac Surg, 2016, 27(2): 498-503.
5	尹恒, 赵树蕃, 郑广宁, 等. 大龄腭裂患者治疗模式的初步研究[J]. 华西口腔医学杂志, 2010, 28(3): 294-297, 302.
	Yin H, Zhao SF, Zheng GN, et al. Investigation of the optimized surgical procedure for the cleft palate patients over six years old[J]. West China J Stomatol, 2010, 28(3): 294-297, 302.
6	Nabi S, Tan S, Husein M, et al. Superiorly based pharyngeal flap for velopharyngeal insufficiency: intermediate and longer-term perceptual speech and nasometric outcomes[J]. J Otolaryngol Head Neck Surg, 2011, 40(2): 157-166.
7	Boutros S, Cutting C. The lateral port control pharyn-geal flap: a thirty-year evolution and followup[J]. Plast Surg Int, 2013, 2013: 237308.
8	Luo X, Guo C, Yin H, et al. Comparison of Hogan pharyngeal flap and sphincter pharyngoplasty in postoperative velopharyngeal function[J]. Br J Oral Maxillofac Surg, 2020, 58(3): 291-295.
9	Calis M, Ustun GG, Ozturk M, et al. Comparison of the speech results after correction of submucous cleft palate with Furlow palatoplasty and pharyngeal flap combined with intravelar veloplasty[J]. J Craniofac Surg, 2018, 29(1): e100-e103.
10	Golding-Kushner KJ, Argamaso RV, Cotton RT, et al. Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: a report from an International Working Group[J]. Cleft Palate J, 1990, 27(4): 337-348.
11	Glade RS, Deal R. Diagnosis and management of ve-lopharyngeal dysfunction[J]. Oral Maxillofac Surg Clin North Am, 2016, 28(2): 181-188.
12	Haenssler AE, Fang X, Perry JL. Effective velopharyngeal ratio: a more clinically relevant measure of velopharyngeal function[J]. J Speech Lang Hear Res, 2020, 63(11): 3586-3593.
13	Chen PK, Wu JT, Chen YR, et al. Correction of secon-dary velopharyngeal insufficiency in cleft palate patients with the Furlow palatoplasty[J]. Plast Reconstr Surg, 1994, 94(7): 933-943.
14	王国民. 腭咽闭合功能不全的诊断与治疗[J]. 口腔颌面外科杂志, 2003, 13(4): 339-345.
	Wang GM. Diagnosis and treatment of velopharyngeal insufficiency[J]. Chin J Oral Maxillofac Surg, 2003, 13(4): 339-345.
15	鲁勇, 石冰, 宋庆高, 等. 腭裂术后腭咽闭合不全患者成年期腭咽结构特征的分析[J]. 实用口腔医学杂志, 2005, 21(4): 495-498.
	Lu Y, Shi B, Song QG, et al. Velopharyngeal morphology in adults with velopharyngeal incompetence after operation of cleft palate[J]. J Pract Stomatol, 2005, 21(4): 495-498.
16	Leclerc JE, Godbout A, Arteau-Gauthier I, et al. We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients[J]. Laryngoscope, 2014, 124(2): 561-569.
17	Gart MS, Gosain AK. Surgical management of velopharyngeal insufficiency[J]. Clin Plast Surg, 2014, 41(2): 253-270.
18	Gosain AK, Arneja JS. Management of the black hole in velopharyngeal incompetence: combined use of a Furlow palatoplasty and sphincter pharyngoplasty[J]. Plast Reconstr Surg, 2007, 119(5): 1538-1545.
19	Wong LS, Lim E, Lu TC, et al. Management of velopharyngeal insufficiency by modified Furlow palatoplasty with pharyngeal flap: a retrospective outcome review [J]. Int J Oral Maxillofac Surg, 2019, 48(6): 703-707.
20	Liao YF, Chuang ML, Chen PK, et al. Incidence and severity of obstructive sleep apnea following pharyngeal flap surgery in patients with cleft palate[J]. Cleft Palate Craniofac J, 2002, 39(3): 312-316.
21	Hogan VM. A clarification of the surgical goals in cleft palate speech and the introduction of the lateral port control (l.p.c.) pharyngeal flap[J]. Cleft Palate J, 1973, 10: 331-345.
22	Rudnick EF, Sie KC. Velopharyngeal insufficiency: current concepts in diagnosis and management[J]. Curr O-pin Otolaryngol Head Neck Surg, 2008, 16(6): 530-535.
23	Instrum R, Dzioba A, Dworschak-Stokan A, et al. Surgical interventions in velopharyngeal dysfunction: compa-rative perceptual speech and nasometric outcomes for th-ree techniques[J]. J Otolaryngol Head Neck Surg, 2022, 51(1): 3.
24	Ysunza PA, Chaiyasate K, Rontal M, et al. Comparison of three different surgical techniques for designing pharyngeal flaps according to findings of videonasopharyngoscopy and multiplanar videofluoroscopy[J]. Int J Pediatr Otorhinolaryngol, 2019, 120: 123-129.
25	管新明, 谢洪. 上蒂高位咽后壁瓣移植术及其临床效果评价[J]. 实用美容整形外科杂志, 1997, 8(6): 306-308.
	Guan XM, Xie H. Upper pedicle pharyngial flap operation and the evaluation of the clinical result[J]. J Pract Aesthetic Plast Surg, 1997, 8(6): 306-308.
26	赵欣然, 蔡鸣. 不同咽成形术式对腭裂术后继发腭咽闭合功能不全合并睡眠呼吸障碍的影响[J]. 中国口腔颌面外科杂志, 2021, 19(1): 76-81.
	Zhao XR, Cai M. A retrospective analysis of sleep brea-thing disordered after pharyngoplasty for velopharyngeal insufficiency secondary to cleft palate[J]. China J Oral Maxillofac Surg, 2021, 19(1): 76-81.
27	Owsley JQ Jr, Creech BJ, Dedo HH. Poor speech following the pharyngeal flap operation; etiology and treatment[J]. Cleft Palate J, 1972, 9: 312-318.

项目		病例构成
性别	男	13
	女	20
腭裂手术年龄/岁		7.3±7.2
VPI手术年龄/岁		20.4±7.9
诊断	单侧唇腭裂	9
	双侧唇腭裂	5
	单纯腭裂	19
腭咽间隙/mm		9.3±3.9

项目	术前	术后
鼻漏气
无	0	25
轻度	2	7
中度	22	1
重度	9	0
高鼻音
正常	0	23
轻度	1	9
中度	20	1
重度	12	0

级别	术前	术后
Ⅰ级	0	30
Ⅱ级	5	3
Ⅲ级	28	0

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[2]	Wang Xi, Guo Chunli, Shi Bing, Yin Heng. Velopharyngeal closure pattern and speech characteristics of patients congenital velopharyngeal insufficiency [J]. West China Journal of Stomatology, 2020, 38(6): 662-666.
[3]	Liu Chuxian,Li Jingtao,Zheng Qian,Guo Chunli,Yin Heng. Factors affecting the postoperative velopharyngeal function among aged patients with cleft palate [J]. West China Journal of Stomatology, 2019, 37(6): 626-630.
[4]	Liu Chao, Qin Chuanqi, Wang Yan, Li Wei, Zheng Qian, Shi Bing.. A follow-up study on velopharyngeal airway condition post pharyngoplasty [J]. West China Journal of Stomatology, 2013, 31(5): 476-478.
[5]	Yin Heng, Guo Chunli, Shi Bing, Zhao Shufan. A preliminary study on the consonant articulation of older patients with cleft palate [J]. West China Journal of Stomatology, 2013, 31(2): 182-185.
[6]	Yin Heng, Ma Li, Shi Bing, Guo Chunli, Zhao Shufan, Li Yang. A study on the application of the perceptual assessment in the diagnosis of the velopharyngeal function [J]. West China Journal of Stomatology, 2012, 30(2): 197-200.
[7]	LI Bei1, SHI Bing2, YIN Heng2, LI Yang2. Effects of speech training on velopharyngeal insufficiency in patients with cleft palate [J]. West China Journal of Stomatology, 2010, 28(06): 623-625.
[8]	WU Yi-lai,WANG Guo-min, YANG Yu-sheng,CHENYang,JIANGLi-ping. Primary Study of Pharyngeal Flap Surgery in Congenital Velopharyngeal Insufficiency [J]. West China Journal of Stomatology, 2005, 23(06): 492-494.
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