Talk:Velopharyngeal insufficiency

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Conclusion

Pharyngeal flap and sphincter pharyngoplasty seem to be safe and reliable procedures for treating velopharyngeal dysfunction. Although complete closure will be not be achieved in all patients after the surgical intervention, most show a reduction of the size of the velopharyngeal opening. Choosing the right surgical procedure for the patient is the most important aspect of the surgery for correcting velopharyngeal dysfunction.^[1] To clarify the problems of each individual patient, diagnosis will be confirmed by hearing (speech analysis) and imaging (videofluoroscopy and nasoendoscopy) the defect. It is important to think about that these different diagnostic procedures can give a various result, because of the fact that what you hear does not necessarily correlate with what is seen.^[2]

The preoperative planning will give you important information about the movement of the soft palate, the lateral pharyngeal walls and posterior pharyngeal wall. The part of the soft palate with the maximal movement, gives you the precise level where tissue has to be attached. This information decides the length of the pharyngeal flap or lateral flaps. Likewise, the size and shape of the gap is considered for determining the width of the pharyngeal flap or lateral flaps. The dissymmetry will be corrected by placing an asymmetric flap or creating unilateral a wider flap in the sphincteroplasty procedure. This is why diagnostic tools contribute immensely in the approach of the problem, and consequently decide if the operation can be called a success.^[1] Moreover, it is concluded that the diagnostic tool that should be used has to be chosen on the aspect of the velopharyngeal defect of the individual.^[3]

A recent meta-analysis which used two RCT's (Randomised Controlled Trial), currently provides the highest quality data in comparing pharyngeal flap with sphincter pharyngoplasty. This study suggests a possible trend favouring the pharyngeal flap.^[4] However, in this meta-analysis only one out of two RCT’s shows a better outcome for the pharyngeal flap, the other RCT doesn’t show any difference. What’s needed next is more research to be done, so that the result of the meta-analysis can be supported.

--Ozzie10aaaa (talk) 18:33, 26 February 2019 (UTC)[reply]

References

^ ^a ^b Ysunza A, Pamplona C, Ramirez E, et al. Velopharyngeal surgery: A prospective randomised study of Pharyngeal Flaps and Sphincter Pharyngoplasties.Plast Reconstr Surg 2002 110(6):1401-7
^ Cite error: The named reference Velopharyngeal insufficiency and secondary palatal management. was invoked but never defined (see the help page).
^ Cite error: The named reference Comparison between multiview videofluoroscopy and nasoendoscopy of velopharyngeal movements. was invoked but never defined (see the help page).
^ Cite error: The named reference Pharyngeal flap versus sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency was invoked but never defined (see the help page).

[Velopharyngeal_surgery-1] Ysunza A, Pamplona C, Ramirez E, et al. Velopharyngeal surgery: A prospective randomised study of Pharyngeal Flaps and Sphincter Pharyngoplasties.Plast Reconstr Surg 2002 110(6):1401-7

[Velopharyngeal_insufficiency_and_secondary_palatal_management.-2] Cite error: The named reference Velopharyngeal insufficiency and secondary palatal management. was invoked but never defined (see the help page).

[Comparison_between_multiview_videofluoroscopy_and_nasoendoscopy_of_velopharyngeal_movements.-3] Cite error: The named reference Comparison between multiview videofluoroscopy and nasoendoscopy of velopharyngeal movements. was invoked but never defined (see the help page).

[Pharyngeal_flap_versus_sphincter_pharyngoplasty_for_the_treatment_of_velopharyngeal_insufficiency-4] Cite error: The named reference Pharyngeal flap versus sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency was invoked but never defined (see the help page).

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