AAFPRS045 - The Customized Surgical Treatment of VPI with Pharyngeal Flaps
Wednesday, April 27, 2022
4:35 PM – 4:40 PM CT
Location: Landmark D
Rohun Gupta; Elizabeth M Boudiab, MD; Emanuela C Peshel, MD; Yousef Ibrahim; Kongkrit Chaiyasate, MD; Kenneth Shaheen, MD; Matthew Rontal, MD; Prasad Thottam, DO; Pablo Antonio Ysunza, MD, PhD, CCC-SLP
Oakland University William Beaumont School of Medicine (Gupta, Ibrahim, Chaiyasate, Shaheen, Rontal, Thottam);
Department of General Surgery, Beaumont Health System (Boudiab, Peshel);
Ian Jackson Craniofacial and Cleft Palate Clinic (Chaiyasate, Shaheen, Yzunza);
Department of Plastic Surgery, Beaumont Health System ( Chaiyasate, Shaheen);
Department of Otolaryngology, Beaumont Health System (Rontal, Thottam)
Oakland University William Beaumont School of Medicine
Background The pharyngeal flap remains a common procedure for correcting velopharyngeal insufficiency (VPI) and demonstrates superiority when compared to sphincter pharyngoplasty. VPI correction is not a one size fits all procedure and this warrants the importance of customization that suits the individual patient’s anatomic and functional pathology.
Learning Objective To discuss if pre-procedural assessment produces successful outcomes in the surgical treatment of VPI despite differences in surgeons.
Study Objective To study if the customization of pharyngeal flaps - using a dynamic pre-procedural assessment - is able to produce reliable and successful outcomes in the surgical treatment of VPI, despite differences in surgeon experience, approach, and technique.
Design Type This is a retrospective patient review.
Methods A total of one-hundred-seventy cases of VPI with pharyngeal flap surgery were reviewed between the ages of four and eighteen. Four surgeons performed two different surgical techniques. Cases were evaluated by a multidisciplinary team and underwent MPVF and FVNP. Individualized preoperative planning was performed based on the findings.
Results One-hundred-fifteen patients (92%) demonstrated overall success of the procedure while thirteen patients (8%) had failure of VPI correction. The most common cause of failed VPI correction was persistent VPI inferior to the pharyngeal flap. There was no significant association between surgical technique and unsuccessful corrections.
Conclusion The optimal surgical approach to VPI is individualized based on preoperative imaging. Our study demonstrates that despite variations in approach to superior based laryngeal flaps, high rates of success are seen in all surgeons.