Comparative analysis of speech outcomes in the treatment of velopharyngeal insufficiency: Traditional superior-based pharyngeal flap and pharyngeal flap combined with radical intravelar veloplasty

Background: Pharyngeal flap (PF) is a commonly used surgical technique in the treatment of velopharyngeal insufficiency (VPI), but it still faces limitations that have not been overcome. The present study aims to objectively analyze the results of PF combined with velar muscle repair, which aims to transform the static structure of PF into a dynamic one, addressing one of its limitations. Patients and Methods: Patients were divided into two groups based on the surgical technique: Group 1: the traditional PF group and Group 2: PF with radical intravelar veloplasty (PF-RIVVP) group. Acoustic evaluation of the velopharyngeal unit (VFU) and nasality level was conducted using a nasometry device during the preoperative period and at 1-year postoperative follow-up. Direct anatomical evaluation of the VFU was performed using a flexible fiberoptic endoscope. Student's t-test and Chi-square test were used for statistical analysis. Results: The mean preoperative nasalance score was 56.5 ± 11.0 in Group 2 and 59.9 ± 10.3 in Group 1. The postoperative mean nasalance score was 29.2 ± 3.1 in Group 2 and 35.3 ± 3.1 in Group 1. Although no statistically significant difference was observed in the mean preoperative nasalance scores, a statistically significant difference was found in the postoperative scores (P < 0.001). Furthermore, nasopharyngoscopic evaluation revealed a superior velopharyngeal movement in Group 2. Conclusion: Through the objective evaluation techniques, the present study demonstrates that PF combined with velar muscle repair provides an enhanced velopharyngeal function in the treatment of VPI compared to the traditional technique.