Pharyngeal flap surgery

Pharyngeal flap surgery is a surgical procedure primarily used to correct velopharyngeal insufficiency (VPI), which is a condition where there is an abnormal opening between the nasal cavity and the oral cavity due to an inadequacy of the velum (soft palate) to completely close against the back wall of the throat during speech. This condition often results in hypernasal speech. Pharyngeal flap surgery is commonly performed on individuals with cleft palate and other conditions that affect speech articulation.

Overview

The main goal of pharyngeal flap surgery is to improve speech quality by reducing nasal air emission and hypernasality. During the procedure, a flap of tissue is taken from the posterior pharyngeal wall and attached to the velum. This creates a permanent physical barrier that reduces the airflow into the nasal passages during speech, thereby improving the clarity and sound of the voice.

Indications

Pharyngeal flap surgery is indicated for patients with significant velopharyngeal insufficiency who have not responded adequately to speech therapy alone. It is often recommended for individuals with:

• Cleft palate or submucous cleft palate
• Congenital conditions that affect the structure or function of the velopharyngeal mechanism
• Acquired conditions, such as after adenoidectomy, that lead to VPI

Procedure

The surgery is performed under general anesthesia. The surgeon makes an incision in the posterior pharyngeal wall to raise a flap of tissue, which is then attached to the velum. The size and position of the flap are carefully planned to ensure that it effectively reduces nasal air emission without causing obstructive sleep apnea or significant difficulty with swallowing.

Risks and Complications

As with any surgical procedure, pharyngeal flap surgery carries risks, including:

• Bleeding
• Infection
• Obstructive sleep apnea
• Difficulty swallowing
• Speech problems, such as too much nasal air emission or hyponasality

Postoperative Care

After surgery, patients typically require a short hospital stay. Speech therapy is often recommended to help the patient adjust to the changes in their speech mechanism and to optimize speech outcomes.

Outcomes

Many patients experience significant improvements in speech clarity and quality after pharyngeal flap surgery. However, outcomes can vary based on the individual's specific condition and the skill of the surgeon. Ongoing speech therapy may be necessary to achieve the best possible speech results.

See Also

• Cleft palate
• Velopharyngeal insufficiency
• Speech therapy