Document Detail

Cerclage sphincter pharyngoplasty: a new technique for velopharyngeal insufficiency.
MedLine Citation:
PMID:  17343926     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Several surgical techniques are available for the treatment of velopharyngeal insufficiency (VFI). Each method has its own complications and non-dynamic roles. So the aim of this study was to present a novel physiological surgical technique designed by the author for reconstruction of the velopharyngeal sphincter in VFI. METHODS: This prospective study included six patients with VFI (two males and four females) with ages from 5 to 20 years (mean: 12.50 years). Speeches, nasopharyngeal and oral endoscopies for velopharyngeal valve closure were measured according to a 5-point scale where 0 was equivalent to normal and 4 meant a severe (constant) deviation. They were scheduled for cerclage sphincter pharyngoplasty after failure of appropriate speech therapy. Under general anaesthesia and the patient in semiflower's position; two level cerclages (1-0 polypropylene suture materials) were inserted behind the muscles of the velopharynx. The first at the level of junction of posterior and middle one-thirds of the soft palate passing through soft palate, left lateral pharyngeal wall, posterior pharyngeal wall, right lateral pharyngeal wall and the soft palate. The second was at 3mm in front of the latter. The surgical technique was described in details. RESULTS: Before surgery five patients (83.3%) had sever hypernasality (rating scale 3). After the cerclage operation and speech therapy four patients (66.6%) significantly improved to normal nasality (rating scale 0) and the remaining two patients improved to mild and moderate hypernasality (rating scale 1 and 2), respectively (p<0.05). By endoscopy the closing activity was (rating scale 3) in five patients (83.3%) and (rating scale 2) in one patient (18%). After the cerclage operation and speech therapy five patients (83.3%) changed significantly to complete closure (rating scale 0) and to (rating scale 1) in one patient (p<0.05). CONCLUSIONS: Cerclage sphincter pharyngoplasty is a new procedure designed by the author in VFI. It helps the velopharynx to function physiologically in three-dimensional patterns without dependency on the type of closure. Also it is an easy technique; without tissue flaps transfer, upper airway obstruction or hyponasality.
Ahmed Ragab
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Publication Detail:
Type:  Journal Article     Date:  2007-03-06
Journal Detail:
Title:  International journal of pediatric otorhinolaryngology     Volume:  71     ISSN:  0165-5876     ISO Abbreviation:  Int. J. Pediatr. Otorhinolaryngol.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-23     Completed Date:  2007-07-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003603     Medline TA:  Int J Pediatr Otorhinolaryngol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  793-800     Citation Subset:  IM    
ORL department, Menoufiya University Hospital, Egypt.
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MeSH Terms
Endoscopy / methods*
Otorhinolaryngologic Surgical Procedures / methods*
Palate, Soft / physiopathology*,  surgery*
Pharyngeal Muscles / physiopathology*,  surgery*
Prospective Studies
Reconstructive Surgical Procedures / methods*
Speech Disorders / diagnosis,  therapy
Speech Production Measurement
Speech Therapy
Velopharyngeal Insufficiency / physiopathology*,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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