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Augmentation of the posterior pharyngeal wall with autologous tragal cartilage for velopharyngeal valve insufficiency after repair of cleft palate in pediatric patients

Abstract

Purpose

The aim of this study was to evaluate posterior pharyngeal wall augmentation using autologous tragal cartilage graft in patients with velopharyngeal valve insufficiency (VPI) after simple palatoplasty for cleft palate.

Patients and methods

This study included 18 patients with postpalatoplasty VPI (grade 2 or 3), with ages ranging from 5 to 14 years. Patients were followed up for 24–48 months postoperatively. Percent of speech intelligibility and grade of closure of velopharyngeal valve with nasopharyngoscope were evaluated preoperatively and postoperatively.

Results

Statistically significant improvement in grade of closure of velopharyngeal valve (P=0.001) and percent of intelligibility (P=0.001) was found after surgery.

Conclusion

Augmentation of the posterior pharyngeal wall using tragal cartilage is a safe technique, with generally good surgical and phoniatric outcomes in the management of pediatric patients with grades 2 and 3 VPI after simple palatoplasty to overcome hypernasality.

References

  1. 1

    Zhao S, Xu Y, Yin H, Zheng Q, Wang Y, Zhong T, et al. Incidence of postoperative velopharyngeal insufficiency in late palate repair. J Craniofac Surg 2012; 23:1602–1606.

    Article  Google Scholar 

  2. 2

    Jayaram R, Huppa C. Surgical correction of cleft lip and palate. Front Oral Biol 2012; 16:101–110.

    Article  Google Scholar 

  3. 3

    Lypka M, Bidros R, Rizvi M, Gaon M, Rubenstein A, Fox D, Cronin E. Posterior pharyngeal augmentation in the treatment of velopharyngeal insufficiency: a 40-year experience. Ann Plast Surg 2010; 65:48–51.

    Article  CAS  Google Scholar 

  4. 4

    Cao Y, Ma T, Wu D, Yin N, Zhao Z. Autologous fat injection combined with palatoplasty and pharyngoplasty for velopharyngeal insufficiency and cleft palate: preliminary experience. Otolaryngol Head Neck Surg 2013; 149: 284–291.

    Article  Google Scholar 

  5. 5

    Ulkur E, Karagoz H, Uygur F, Celikoz B, Cincik H, Mutlu H, et al. Use of porous polyethylene implant for augmentation of the posterior pharynx in young adult patients with borderline velopharyngeal insufficiency. J Craniofac Surg 2008; 19:573–579.

    Article  Google Scholar 

  6. 6

    Sipp JA, Ashland J, Hartnick CJ. Injection pharyngoplasty with calcium hydroxyapatite for treatment of velopalatal insufficiency. Arch Otolaryngol Head Neck Surg 2008; 134:268–271.

    Article  Google Scholar 

  7. 7

    Hess DA, Hagerty RF, Mylin WK. Velar motility, velopharyngeal closure, and speech proficiency in cartilage pharyngoplasty: an eight year study. Cleft Palate J 1968; 5:153–162.

    PubMed  CAS  Google Scholar 

  8. 8

    Bassiouny SE, Mona AH, Jilan FN, Mohsen, Amel SS. A Abdelahamid. Development of an Arabic speech intelligibility test for children. Egypt J Otolaryngol 2013; 29:202–206.

    Google Scholar 

  9. 9

    Orr WC, Levine NS, Buchanan RT. Effect of cleft palate repair and pharyngeal flap surgery on upper airway obstruction during sleep. Plast Reconstr Surg 1987; 80:226–232.

    Article  CAS  Google Scholar 

  10. 10

    Sirois M, Caouette-Laberge L, Spier S, Larocque Y, Egerszegi EP. Sleep apnea following a pharyngeal flap: a feared complication. Plast Reconstr Surg 1994; 93:943–947.

    Article  CAS  Google Scholar 

  11. 11

    Trier WC. Pharyngeal flaps for the correction of velopharyngeal insufficiency. In: Cohen M, eds. Mastery of plastic and reconstructive surgery. Vol. I. 1st ed. Boston, MA: Little, Brown & Co; 1994;633.

    Google Scholar 

  12. 12

    Gersuny R. About a subcutaneous prosthesis. Zschr Heilk 1900; 21: 199–204.

    Google Scholar 

  13. 13

    Eckstein H. Demonstration of paraffin prosthesis in defects of the face and palate. Dermatologica 1904; 11:772–778.

    Article  Google Scholar 

  14. 14

    Blocksma R. Silicone implants for velopharyngeal incompetence: a progress report. Cleft Palate J 1964; 16:72–81.

    PubMed  CAS  Google Scholar 

  15. 15

    Furlow LTJr, Williams WN, Eisenbach CR, Bzoch II, KR. A long term study on treating velopharyngeal insufficiency by teflon injection. Cleft Palate J 1982; 19:47–56.

    PubMed  Google Scholar 

  16. 16

    Remacle M, Bertrand B, Eloy P, Marbaix E. The use of injectable collagen to correct velopharyngeal insufficiency. Laryngoscope 1990; 100:269–274.

    Article  CAS  Google Scholar 

  17. 17

    Von Gaza W. Transplanting of free fatty tissue in the retropharyngeal area in cases of cleft palate. Paper presented at German Surgical Society;9 April 1926.

  18. 18

    Wolford LM, Oelschlaeger M, Deal R. Proplast as a pharyngeal wall implant to correct velopharyngeal insufficiency. Cleft Palate J 1989; 26119–126 discussion 126–128.

  19. 19

    Witt PD, O’Daniel TG, Marsh JL, Grames LM, Muntz HR, Pilgram TK. Surgical management of velopharyngeal dysfunction: outcome analysis of autogenous posterior pharyngeal wall augmentation. Plast Reconstr Surg 1997; 99:1287–1296 discussion 1297–1300.

    Article  CAS  Google Scholar 

  20. 20

    Trigos I, Ysunza A, Gonzalez A, Vazquez MC. Surgical treatment of borderline velopharyngeal insufficiency using homologous cartilage implantation with videonasopharyngoscopic monitoring. Cleft Palate J 1988; 25:167–170.

    PubMed  CAS  Google Scholar 

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Correspondence to Ahmed G. Khafagy.

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Khafagy, A.G., Rabie, A.N. & Abdelhamid, A. Augmentation of the posterior pharyngeal wall with autologous tragal cartilage for velopharyngeal valve insufficiency after repair of cleft palate in pediatric patients. Egypt J Otolaryngol 33, 45–49 (2017). https://doi.org/10.4103/1012-5574.199409

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Keywords

  • augmentation
  • autologous
  • cartilage
  • cleft palate
  • posterior pharyngeal wall
  • tragal
  • velopharyngeal valve insufficiency