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Secondary Pharyngoplasty: Management And Outcomes
Pang JH, Chen W, Zhu X, James I, Brooker J, Lee JY, Goldstein J, Losee JE
University of Pittsburgh Medical Center
2017-02-15
Presenter: John Henry Pang
Affidavit:
I certify that the work on this project represents the original work of the resident
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background –Failure rates of pharyngoplasty (PPF or SP) range from 15-20%. There is a paucity of literature on the role, technique, and, most importantly, speech outcomes of secondary procedures, which include repeating or revising the pharyngoplasty.
Methods – A retrospective review was performed of all patients who underwent pharyngoplasty by a senior surgeon. We evaluated demographics, medical comorbidities, surgical details, complications, and speech history. Additionally, a subgroup analysis was performed on patients exclusively cared for by the senior author with a homogeneous treatment algorithm for velopharyngeal insufficiency (VPI).
Results – 258 patients who underwent a pharyngoplasty were identified (240 PPF, 18 SP). Index procedures included pharyngoplasty 39(15%) or palatoplasty 219(85%).
Twenty-eight patients (26 primary PPF, 2 primary SP) required secondary pharyngoplasty; PPF(21) or SP(7). Nine (32.1%) were syndromic, 6(21.4%) had PRS, 1(3.6%) had VCF, and the most frequent cleft was a Veau II (35.7%). The most common complication requiring secondary pharyngoplasty was VPI 13(46%). Average speech scores improved (12 vs 8) and were near normal (3) by the time of tertiary procedures.
A Subgroup analysis of patients exclusively cared for by the senior surgeon (76) demonstrated a lower complication rate (19.7% vs 56.0% p=0.000), reoperation rate (7.9% vs 51.9% p=0.000), and need for secondary pharyngoplasty (1.3% vs 11.7% p=0.000), with similarly optimal speech outcomes.
Conclusion – Current literature lacks a comprehensive description of secondary pharyngoplasty. Our study demonstrates complex VPI patients requiring secondary procedures can have improved speech outcomes. Furthermore, the outcomes of our subgroup analysis validates our algorithm for VPI management.
