Surgical correction of velopharyngeal insufficiency in cleft palate patients with two procedures of reconstruction of radical intravelar veloplasties (IVVs)

Abstract

Objective To summarize the clinical outcomes of surgical correction of velopharygeal insufficiency (VPI) with two procedures of radical intravelar veloplsties, and to discuss the indication selection of surgical technique. Methods 58 cases of various cleft palate were speech evaluated and diagnosed as mild to moderate VPI, who aged from 3 to 28 years (mean age 7.5 years). Group I (36 cases) were performed surgery in the way of modified Furlow double-opposing Z-plasty. Group Ⅱ (22 cases) were performed surgery in the way of Sommerald radical IVV. All cases were followed up for 6 months to 1 year after surgery, with speech evaluation and objective examination of nasopharygoscopy and fixed position lateral X ray. The X-ray images of lateral view of velum was read through PACS image system. The effective work length of soft palate and the pharyngeal gap of the velum at rest and function were measured directly through PACS system. The data of each case before and after surgery were compared. Results 34 of 36 cases (94.50%) in modified-Furlow group and 21 of 22 cases (95.5%) in Sommerlad group finally recovered complete velopharyngeal closure. Compared between before and post operation, the effective work length of soft palate in modified Furlow group increased by 9.50±2.35 mm, the length in Sommerlad group increased by 7.50±3.32 mm. The differences were statistically significant by paired T test (P<0.001). None of all cases complained nasal airway obstruction. Conclusions Both types of radical IVVs are highly effective to be recommended for surgical correction of mild to moderate VPI. Strict selection of surgical indication and excellent surgical skill are necessary for good treatment outcomes. Key words: Cleft palate; Velopharygeal insufficiency; Intravelar veloplasty; Furlow veloplasty; Sommerlad veloplasty