Management of velopharyngeal insufficiency by a new modification of sphincter pharyngoplasty technique in cleft palate patients, clinical and radiographical prospective study.

Background: This study was designed to investigate the effectiveness and outcome of a new modification of the sphincter pharyngoplasty technique in the treatment of velopharyngeal insufficiency patients, with the determination of a specific dimension of velopharyngeal port and velum length of no hypernasality, snoring, and nasal regurgitation potential.

Materials And Methods: The study included 10 patients, who were suffering from consistent hypernasal speech after failure of conservative speech therapy. Clinical and radiographic measurements of the velopharyngeal port and velum length before and after surgery were done, with clinical patient follow-up to assess snoring and nasal regurgitation after surgery for 1, 6, and 12 months.

Results: Before surgery, the mean clinical anteroposterior distance/velopharyngeal depth was 16.40±1.7 mm, and the mediolateral distance was 20.20±3.4 mm. After surgery, the mean anteroposterior distance decreased to 8±0.9 mm, and the mean mediolateral distance decreased to 12.60±2.06 mm. Both measurements showed statistically significant (=0.0001). After 12 months postoperatively, the radiographic CT axial anteroposterior distance was 12.09±1.4 mm, and the mean mediolateral distance was 19.82±5.6 mm, compared to the mean CT anterioposterior before surgery 15.60±2 mm and mediolaterally 21.28±2.7 mm. The anteroposterior measurement showed a statistically significant (=0.002), while the mediolateral measurement did not (=0.3). The mean velum length before surgery was 25.80±1.5 mm and 27.03±0.6 mm after 12 months postoperatively. Snoring and nasal regurgitation occurrence were assessed at 1, 6, and 12 months postoperatively, with all reports being negative.

Conclusion: Sphincter pharyngoplasty using posterior tonsillar pillars for treating VPI patients results in improved speech outcomes without snoring or nasal regurgitation.