Under what circumstances would you choose a sphincter Pharyngoplasty over a pharyngeal flap for secondary speech surgery?

If the patient have the coronal closure pattern and small or intermediate gap of VP port, the sphincter pharyngoplasty is recommended. If the patient with the poor movement of lateral pharyngeal wall is treated by pharyngeal flap, the incidence of airway obstruction is increased.

What is the purpose of a Pharyngoplasty?

Pharyngoplasty is an operation to change the shape and function of the soft palate and the area around it called the pharynx.

What is a sphincter Pharyngoplasty?

Sphincter pharyngoplasty (SFINK-ter far-INGO-plasty) is a surgery done to help correct velopharyngeal dysfunction (VEE-lo-fa-RIN-jee-uhl dis-FUNK-shuhn), or VPD. VPD occurs when the soft palate cannot properly separate the back of the mouth from the nose during speech.

How is velopharyngeal insufficiency diagnosed?

How is velopharyngeal insufficiency (VPI) diagnosed?

1. Endoscopy, using a medical device with lights attached that allow doctors to see inside the mouth.
2. Videofluoroscopy, a type of X-ray that uses a liquid called barium to provide contrast that makes it easy for a doctor to examine the back of the mouth.

What is Hynes Pharyngoplasty?

The Hynes pharyngoplasty is the second most often performed procedure for velopharyngeal insufficiency in the United Kingdom and Ireland. A crucial step of the procedure is reliable fixation of the flaps onto the posterior pharynx wall. We prefer to fix the flaps to the prevertebral fascia.

What is lateral Pharyngoplasty?

In 2003, Cahali described lateral pharyngoplasty, a surgical technique designed to splint the lateral pharyngeal walls via a microdissection of the superior pharyngeal constrictor muscle, thus giving support to these walls and reducing lateral collapse in patients with OSAS.

What kind of disorder is Hypernasality?

Hypernasal speech is a disorder that causes abnormal resonance in a human’s voice due to increased airflow through the nose during speech. It is caused by an open nasal cavity resulting from an incomplete closure of the soft palate and/or velopharyngeal sphincter.

What is a submucous cleft palate?

A submucous cleft palate (SMCP) results from a lack of normal fusion of the muscles within the soft palate as the baby is developing in utero. It occurs in about 1 in 1,200 children. There is no single cause of SMCP, but current research suggests a combination of genetic and environmental factors.

What are the symptoms of velopharyngeal dysfunction?

Signs and symptoms of VPD may include:

• Excessively nasal speech quality (also known as hypernasality)
• Leakage of air through the nose while speaking.
• Speech which sounds weak or muffled.
• Abnormal articulation.
• Leakage of food or liquid through the nose while eating.

What is the difference between velopharyngeal incompetence and insufficiency?

Velopharyngeal insufficiency (VPI), which is due to abnormal structure. Velopharyngeal incompetence (VPI), which is due to abnormal movement. Velopharyngeal mislearning, which is due to abnormal speech sound production.

How do you sleep after throat surgery?

Sleep with head elevated (at 45 degrees) for at least three days. Elevating your head during sleep decreases blood flow to the head and neck regions. Therefore, it decreases swelling and the associated pain. Elevating the head during sleep may also improve breathing patterns in other ways.

What is the difference between hypernasality and Hyponasality?

Hypernasality—occurs when there is sound energy in the nasal cavity during production of voiced, oral sounds. Hyponasality—occurs when there is not enough nasal resonance on nasal sounds due to a blockage in the nasopharynx or nasal cavity.

What does Hyponasality sound like?

Hyponasal speech is the sound of speech that results from too little air escaping through the nose (sounds like talking with a stuffy nose). It would be hard to normally pronounce the letter “m” for example.

What does submucous cleft look like?

In many cases, the submucous cleft can be seen by looking in the mouth. The uvula may be small, square or bifid (split down the middle). The soft palate may appear to be thin or bluish in color. When the child says “ah,” the velum may seem to go up in the shape of a tent.

What are the main leading causes of velopharyngeal dysfunction?

What Causes Velopharyngeal Dysfunction?

• history of cleft palate.
• submucous cleft palate.
• 22q deletion syndrome (DiGeorge syndrome)
• problems with the palate or throat.
• adenoidectomy.
• traumatic brain injury or other neurological disorders.

How do you assess velopharyngeal function?

Visual imaging is another common approach to evaluating velopharyngeal function in clinical practice. One type of imaging is videonasendoscopy, which involves passing a flexible endoscope posteriorly through the nasal pathways and viewing the velopharynx from above.

Who can diagnose velopharyngeal insufficiency?

Velopharyngeal incompetence (VP incompetence) means there is a problem in how the soft palate moves to make speech sounds. It is possible to have more than one type of VPD. A speech and language pathologist (SLP) specializing in VPD will help determine what types your child has.

Do they remove your uvula when they remove your tonsils?

UPPP removes excess tissue from the soft palate and pharynx. Your doctor may also remove the tonsils, adenoids, and all or part of the uvula during this procedure.

What is sphincter pharyngoplasty used for?

Sphincter pharyngoplasty First described in 1950 by Hynes for patients with velopharyngeal insufficiency following cleft palate repair, the sphincter pharyngoplasty is a frequently used procedure for treating velopharyngeal insufficiency that rivals the pharyngeal flap in some centers as the most frequently used procedure. …

Is sphincter pharyngoplasty better than posterior pharyngeal flap?

In the last two decades, sphincter pharyngoplasty has become more commonly used to correct VPD, and in many studies is noted to have comparable or even favorable outcomes compared to the “workhorse” posterior pharyngeal flap procedure.

Is sphincter pharyngoplasty an effective treatment for levator veli Palatine (VPD)?

The authors use sphincter pharyngoplasty as the surgical procedure for treatment of VPD in patients with transverse orientation of the levator veli palatine. An algorithm for management as developed at Seattle Children′s Hospital is presented in Fig. 13.1 . In this chapter, we present the sphincter pharyngoplasty in detail.

What is velopharyngeal insufficiency (VPI) surgery?

The goals of VPI (Velopharyngeal Insufficiency) surgery is to eliminate the symptoms of hypernasality and audible nasal emissions without causing total obstruction of the velopharyngeal port, allowing for nasal breathing and nasal resonance.