Pharyngeal flap in velopharyngeal insufficiency: Proposal of an algorithm in a series of 31 patients

N Ben Slama; C Maquet; O Trost; J B Leca

doi:10.1016/j.jormas.2023.101535

Pharyngeal flap in velopharyngeal insufficiency: Proposal of an algorithm in a series of 31 patients

J Stomatol Oral Maxillofac Surg. 2023 Jun 10:101535. doi: 10.1016/j.jormas.2023.101535. Online ahead of print.

Authors

N Ben Slama¹, C Maquet², O Trost³, J B Leca⁴

Affiliations

¹ Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen 76000, France. Electronic address: neil.ben-slama@chu-rouen.fr.
² Department of Otorhinolaryngology-Head and Neck Surgery, Rouen University Hospital, Rouen 76000, France.
³ Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen 76000, France; Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen-Normandie University, 22 Boulevard Gambetta, Rouen 76183, France.
⁴ Department of Pediatric Surgery, Clinique Chirurgicale et Infantile, CHU Charles Nicolle, Rouen, France.

PMID: 37307914
DOI: 10.1016/j.jormas.2023.101535

Abstract

This study evaluated the results of a reproductible protocol indicating the need for a pharyngeal flap in children with cleft palate and velopharyngeal insufficiency (VPI). A retrospective review of all patients operated for a pharyngeal flap between 2010 and 2019 in our center was conducted. After exclusion of patients with primary VPI or residual fistulas, 31 patients' data were analyzed. Our main outcome measure was the improvement of the Borel Maisonny Classification (BMC) by at least 1 rank. Further analysis was made to evaluate the impact of age, type of cleft, and BMC before surgery on the gain in the velopharyngeal function. Of the 31 patients, success was achieved in 29 (93.5%, p<0.005). There was no significant correlation between age and gain in the velopharyngeal function (p = 0.137). There was no significant correlation between type of cleft and gain in the velopharyngeal function (p = 0.148). There was a significant correlation observed between the starting classification and gain in velopharyngeal function. The gain observed was greater as the initial velopharyngeal function was worse (p = 0.035). The use of an algorithm combining clinical assessment with a standardized classification of the velopharyngeal function proved to be a reliable tool for the indication of surgery in patients with VPI. A close follow up is essential in a multidisciplinary team.

Keywords: Borel Maisonny; Pharyngeal flap; Pharyngoplasty; Velopharyngeal insufficiency.