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Pharyngeal Flap Outcomes in Nonsyndromic Children with Repaired Cleft Palate and Velopharyngeal Insufficiency

Sullivan, Stephen R. M.D., M.P.H.; Marrinan, Eileen M. M.S., M.P.H.; Mulliken, John B. M.D.

Plastic and Reconstructive Surgery: January 2010 - Volume 125 - Issue 1 - p 290-298
doi: 10.1097/PRS.0b013e3181c2a6c1
Pediatric/Craniofacial: Original Articles

Background: Velopharyngeal insufficiency occurs in 5 to 20 percent of children following repair of a cleft palate. The pharyngeal flap is the traditional secondary procedure for correcting velopharyngeal insufficiency; however, because of perceived complications, alternative techniques have become popular. The authors' purpose was to assess a single surgeon's long-term experience with a tailored superiorly based pharyngeal flap to correct velopharyngeal insufficiency in nonsyndromic patients with a repaired cleft palate.

Methods: The authors reviewed the records of all children who underwent a pharyngeal flap performed by the senior author (J.B.M.) between 1981 and 2008. The authors evaluated age of repair, perceptual speech outcome, need for a secondary operation, and complications. Success was defined as normal or borderline sufficient velopharyngeal function. Failure was defined as borderline insufficiency or severe velopharyngeal insufficiency with recommendation for another procedure.

Results: The authors identified 104 nonsyndromic patients who required a pharyngeal flap following cleft palate repair. The mean age at pharyngeal flap surgery was 8.6 ± 4.9 years. Postoperative speech results were available for 79 patients. Operative success with normal or borderline sufficient velopharyngeal function was achieved in 77 patients (97 percent). Obstructive sleep apnea was documented in two patients.

Conclusion: The tailored superiorly based pharyngeal flap is highly successful in correcting velopharyngeal insufficiency, with a low risk of complication, in nonsyndromic patients with repaired cleft palate.

Boston, Mass.; and Syracuse, N.Y.

From the Department of Plastic and Oral Surgery and the Craniofacial Centre, Children's Hospital and Harvard Medical School, and the Central New York Cleft and Craniofacial Center, Upstate Medical University Hospital.

Received for publication May 27, 2009; accepted July 28, 2009.

Disclosure: None of the authors has any commercial associations, supporting funds, or financial disclosures that might pose or create a conflict of interest with information presented in this article.

John B. Mulliken, M.D.; Department of Plastic Surgery; Children's Hospital Boston; 300 Longwood Avenue; Boston, Mass. 02115;

©2010American Society of Plastic Surgeons