Cerclage and sphincter pharyngoplasty techniques for management of velopharyngeal insufficiency: How I do it?

Abstract

The activities of swallowing and speaking depend upon the ability to achieve adequate closure of the velopharyngeal (VP) port. Swallowing and speaking are complex motor skills that involve the coordination of diverse groups of muscles between the nasopharynx and oropharynx. Various conditions can affect VP closure function including an adenoidectomy operation. Defects in the VP sphincter can affect the patient’s speech in many ways–for example, induction of hypernasality, decreased speech intelligibility, and nasal emissions. Three main surgical approaches to VP corrective surgery can be used–namely, pharyngoplasty, pharyngeal flap, and posterior pharyngeal wall augmentation. The author of this study designed a new procedure called cerclage sphincter pharyngoplasty to be added for correction of VP insufficiency. Maximum benefit can be achieved when the surgical technique takes advantage of the remaining native VP closure. As pharyngeal flaps are not functional and have multiple drawbacks and because posterior pharyngeal wall augmentation is successful only in case of minor defects, the author focuses on functional techniques used for correction of different closure patterns and grades–namely, cerclage and sphincter pharyngoplasty.