eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Pharyngoplasty and Pharyngeal Flaps: Follow-up

Author: Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Coauthor(s): Erin K McGraw, MA, CCC-SLP/L, Speech-Language Pathologist, Cleft Palate and Craniofacial Team, Shriners Hospital for Children-Chicago; Raja Ramaswamy, MS, The Chicago Medical School; Mary M O'Gara, MA, Director, Cleft Lip and Palate Institute, Inc; Associate Professor, Northwestern University Medical School; Mitchell F Grasseschi, MD, Assistant Professor, Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University; Private Practice, Plastic and Reconstructive Surgery
Contributor Information and Disclosures

Updated: Feb 23, 2009

Outcome and Prognosis

Studies have shown success rates for pharyngeal flap surgery of 80-90%. The classification of failure or success depends on the investigator. Certain studies classify patients with hyponasality as a successful outcome. Other studies classify postsurgical hyponasality of greater than 4 years a failure. In those studies, the success rate is somewhat lower.

Sphincter pharyngoplasty has been associated with lower success rates of 40-60%. More recent studies show that the success rate can reach approximately 80% with appropriate patient selection based on velopharyngeal (VP) port anatomy.

The effectiveness of the Furlow procedure in properly selected patients is reported to be greater than 90% in most series. Ongoing debate in the literature surrounds patient selection for the Furlow procedure.

Future and Controversies

Sufficient prospective and randomized studies have not been performed on the various procedures for repairing a velopharyngeal (VP) port. A coordinated multicenter study that correlates the outcomes for the types of procedures based on VP anatomy is necessary. Such a study must be designed to produce data that can be appropriately interpreted, generalized, and applied by surgeons in making definitive conclusions on the optimal procedure for each patient.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Alexander Margulis, MD, and Glenn Herrmann, MD, to the development and writing of this article.



More on Craniofacial, Pharyngoplasty and Pharyngeal Flaps

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Follow-up: Craniofacial, Pharyngoplasty and Pharyngeal Flaps
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References
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References

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Further Reading

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Keywords

velopharyngeal dysfunction, VPD, velopharyngeal insufficiency, velopharyngeal inadequacy, velopharyngeal incompetence, VPI, VP inadequacy, VP incompetence, VP insufficiency, VP augmentation, velopharyngeal augmentation, cranio-facial surgery, cranio-facial pharyngoplasty, craniofacial pharyngoplasty, pharyngeal flap, speech disorder, resonance disorder, hypernasality, misarticulation, escape of air through the nose, nasal emissions, aberrant facial movements, grimacing, cleft palate repair, cleft palate, structural palate deficiency, myasthenia gravis, cerebrovascular accident, upper motor neuron lesion, lower motor neuron lesion, head trauma, short palate, scarred palate, tightened palate, levator palatini dysfunction, levator palatini malposition, poor pharyngeal wall mobility, misarticulated speech, palatal prosthesis, velar lift, VP obturator, velopharyngeal obturator

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Contributor Information and Disclosures

Author

Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Erin K McGraw, MA, CCC-SLP/L, Speech-Language Pathologist, Cleft Palate and Craniofacial Team, Shriners Hospital for Children-Chicago
Erin K McGraw, MA, CCC-SLP/L is a member of the following medical societies: American Cleft Palate/Craniofacial Association and American Speech-Language-Hearing Association
Disclosure: Nothing to disclose.

Raja Ramaswamy, MS, The Chicago Medical School
Raja Ramaswamy, MS is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Mary M O'Gara, MA, Director, Cleft Lip and Palate Institute, Inc; Associate Professor, Northwestern University Medical School
Disclosure: Nothing to disclose.

Mitchell F Grasseschi, MD, Assistant Professor, Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University; Private Practice, Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Medical Editor

Larry Hollier, Jr, MD, Assistant Professor, Department of Plastic Surgery, Baylor University College of Medicine
Larry Hollier, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, AO Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

S Anthony Wolfe, MD, Chief, Division of Plastic Surgery, Miami Children's Hospital; Voluntary Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami School of Medicine
S Anthony Wolfe, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic and Reconstructive Surgery, Florida Medical Association, and Southeastern Society of Plastic and Reconstructive Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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