Complications Following Posterior Pharyngeal Flap Surgery

Abstract

Since 1955, 222 patients from the Cleft Palate Clinic of the Children's Hospital of Philadelphia have had posterior pharyngeal flaps constructed to treat velopharyngeal incompetence. The need for operation was decided upon jointly after evaluation of the patients by the members of the Cleft Palate Clinic team. These decisions were usually supported by speech testing and radiologic evaluations. The indication for surgery was the consistant demonstration of a signif— icant degree of velopharyngeal incompetence. The majority of operations were carried out before the age of seven years. Methods and results: Twenty—one patients had velopharyngeal imcom— petence due to neurological deficits on an anatomical basis in the absence of a palatal cleft. Fifty—two patients with wide clefts and short palates had pharyngeal flaps constructed at the time of their palatal closure. In the largest group, comprising 65 percent of the total, 149 procedures were carried out in patients with velopharyngeal incompetence after a prior palatal closure. Seven of the patients whose initial construction of a posterior pharyngeal flap failed had a second operation performed (Table 1). Nearly equal numbers of superiorly and inferiorly based flaps were done. 109 flaps were superiorly based, 98 were inferiorly based, and the position of fifteen flaps was not available from the charts. All operations were performed by one of several staff surgeons or by a resident surgeon under their supervision. In two patients, large tonsils were resected to insure a reasonable airway postoperatively. If a superiorly based flap was constructed, the palate was often divided in the midline for exposure. The choice between superiorly and inferiorly based flaps was made by the operating surgeon, with some preference for inferiorly based flaps if From the Cleft Palate Clinic of Children's Hospital of Philadelphia.