Pharyngeal Flap Surgery - Candidacy

Candidacy

Pharyngeal flap surgery may be recommended to resolve velopharyngeal incompetence after patients prove unable to achieve significant speech improvements through speech therapy alone. Other requirements to qualify for the surgery include a short and immobile or easily fatigued palate (Mazaheri et al., 1994).

The patient’s pattern of VP closure is one aspect that is taken take into consideration by doctors in deciding whether pharyngeal flap surgery is the appropriate method of treatment (Armour et al., 2005). A variety of closure patterns have been found, and the pattern varies person to person. When planning pharyngeal flap surgery, it is imperative for the doctor to match the postoperative structure to the preoperative movements in order for an adequate seal to be achieved (Ysunza et al., 2002). Research has found that pharyngeal flap surgery has been most effective for those with a sagittal closure pattern (good lateral wall movement but poor velar movement (Armour et al., 2005).

Pharyngeal flap surgery is not recommended for everyone and alternative treatment methods are available. One alternative is the use of a prosthesis. In some instances, a prosthesis is capable of stimulating pharyngeal wall movement, thus aiding in VP closure. Most often, prostheses have been recommended for use in young children (Mazaheri et al., 1994). Currently, no accurate method is available to determine whether a pharyngeal flap or an alternative method will have better results for eliminating velopharnygeal incompetence.

Pharyngeal flap surgery has been completed in both children and adults. When younger children undergo the surgery, fewer speech impairments tend to occur. A possible explanation is that the earlier the surgery, the less likely the child will have developed compensatory strategies to overcome the velopharyngeal incompetence (Armour et al., 2005). However, with thorough preoperative planning, pharyngeal flap surgery can be just as effective in eliminating VPI in adults as it is in children (Hall et al., 1991).