• Archives of Plastic Surgery
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• 제36권3호
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• pp.294-298
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• 2009

Purpose: The pharyngeal flap is one of the popular surgical method to treat the problem of velopharyngeal dysfunction. This study evaluated speech outcomes of patients who underwent superiorly based pharyngeal flap surgery based on timing of surgery. Methods: A restrospective review of 50 patients who underwent pharyngeal flap surgery for velopharyngeal insufficiency between September 1996 and January 2008 was undertaken. Thirty patients with an available preoprative and postoperative speech assessments with at least 6 months of follow-up were included in this study. We checked out the significance of speech improvement after surgery analysing preoperative and postoperative scoring of speech assessment. We also investigated the direct relationship between the age at surgery and the degree of speech improvement, and the improvement score in different age groups. Results: The mean score of preoperative speech was $52.6{\pm}7.4points$ and postoperative speech was $58.6{\pm}6.5points$, which presented significant postoperative speech improvement with an average of 5.9 points(p<0.01). There was a significant inverse relationship between the age at operation and speech improvement degree(p<0.01, r = -0.54). Comparing the age groups, the age group of 4 to 5 years presented statistically significant speech improvement(p<0.01). Conclusion: we propose that all patients indicated should take pharyngeal flap irrespective of age. In this study, the younger the age at surgery, the higher degree of speech improvement, for which we suggest that surgical approach should be undertaken as early as possible, especially younger than age 5 years.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.23.1-23.6
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• 2018

Background: Velopharyngeal insufficiency that accompanies speech resonance and articulation disorders can be managed through several intervention methods such as speech-language therapy, prosthetic aids, and surgery. However, for patients with severe hypernasality, surgical interventions are highly recommended. Among available surgical techniques, the posterior pharyngeal flap is most common. Case presentation: Two adult males with high nasalance scores underwent superiorly based posterior pharyngeal flap surgery, followed by speech testing by an expert speech-language therapist. Nasalance scores and articulation accuracy were assessed up until 1 year after the surgery. Nasalance scores were measured five times using a nasometer, after which the average value was calculated. Conclusions: Consistent declines in hypernasality over time are not easy to explain since the pedicled pharyngeal flap narrowed over time, secondary to cicatrization. However, scar tethering of the soft palate in a posterior direction could reduce the velopharyngeal port size over time. Therefore, long-term follow-up with intensive speech therapy is suggested for patients with severe hypernasality.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.407-412
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• 2006

Purpose: Various attempts of reconstruction for pharyngoesophageal defects after ablative surgery have been made to restore the function of the pharyngoesophagus. A fabricated tubed radial forearm free flap or free jejunal free flap was used when the width of remnant pharyngeal wall was less than 50% of the normal width. However there are many disadvantages such as stricture, saliva leakage and fistula formation on tubed radial forearm free flap. The jejunal free flap has the problem such as short pedicle, poor tolerance of ischemic time, wet voice and delayed transit of swallowed food due to the uncoordinated contraction. The authors studied the utility of patch-type radial forearm free flap using the remnant posterior pharyngeal wall of the hypopharynx. Methods: Retrospective reviews in Severance Hospital were made on 25 patients who underwent reconstruction surgery with patched radial forearm free flap because of the hypopharyngeal cancer between 1996 and 2005. The patients of Group I had the narrow posterior pharyngeal wall and its width was less than 3centimeters after the tumor was resected. Those of Group II had the partial pharyngectomy and the width of the remnant pharynx was larger than 3 centimeters. Results: Seven patients belonged to the group I and the flap of this group had 100% survival rate. One case of fistula and no swallowing discomfort due to stricture was reported. The Group II including 18 patients also had the 100% flap survival rate. Neither fistula nor stricture was seen but the lower diet grade was checked. Conclusion: The patch type radial forearm free flap using the remnant pharyngeal wall have the advantage of the radial forearm free flap, and furthermore this flap is the safe reconstructive method even if the width of the remnant pharyngeal wall is less than 30% of that of normal pharynx.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권3호
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• pp.384-389
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• 1994

A female child with unilateral midpalatal cleft was successfully treated by Wardill V-Y pushback palatal flap and superiorly based pharyngeal flap simultaneously. The advantages of this method are to prepare the favorable background of postoperative speech correction and additional nasal lining. We can try this simultaneous operation in delayed cleft palate repair.

• 말소리와 음성과학
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• 제1권3호
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• pp.133-144
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• 2009

Pharyngeal flap surgery changes the space and shape of the oral cavity and vocal tract, and these changing conditions bring resonance change. The purpose of this study was to determine the most reliable and valuable parameters for evaluating hypernasality to distinguish two patients before and after pharyngeal flap surgery. Each patient was asked to clearly speak the vowels /a/, /i/, /u/, /e/, /o/ for voice recording. There were nine parameters: Formant (F1, F2, F3), Bandwidth (BW1, BW2, BW3), LPC energy slope ($\Delta$ |A2-A1/F2-F1|), and Band Energy (0-500 Hz, 500-1000 Hz) by each vowel. From the results of discrimination analyses on acoustic parameters, the vowels /a/, /e/ appeared to be insignificant but vowels /i/, /u/, /o/ appeared to be efficient in the separation. A 95%, 100%, and 100% recognition score could be reached when vowels /i/, /u/, and /o/ were analyzed. The results showed that F2, BW3, and LPC slope are more important parameters than the others. Finally, there is a relation between perceptual evaluation score and LPC energy slope of acoustic parameters by least square slope.

• Archives of Plastic Surgery
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• 제32권5호
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• pp.660-662
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• 2005

It is well documented that adenoidectomy is attributed to hypernasality in certain cases, but not clear that the enlarged tonsils affect the quality of speech. Hypertrophied tonsils may cause and complicate the problem of velopharyngeal incompetency. The huge tonsils prevent lateral pharyngeal walls from a medial movement and interfere velar elevation, being hypernasality. Hyponasality developes as the tonsils encroach in nasopharyngeal space. Voluminous tonsils also interfere airflow in the oropharyneal passage and produce the phenomenon of cul-de-sac resonance or muffled sound. The authors and et al. present a case of velopharyngeal insufficiency accompanied with hypertrophic tonsils. Improving the lateral constricting pharyngeal wall and velar elevation after tonsillectomy minimized the velopharyngeal gap. Accordingly, the procedures of sphincter pharyngoplasty and palatal lengthening resolved the problem of hypernasality instead of pharyngeal flap. Tonsillectomy prior to pharyngeal flap surgery tends to reduce the postoperative airway problems. Sometimes, however, only tonsillectomy does without pharyngeal flap. Surgical approach by stages and intermittent evaluation are recommended at intervals of at least six weeks.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권4호
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• pp.309-312
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• 2016

Patients with cleft lip and palate (CLP) must undergo corrective surgeries during infancy and early childhood. Many patients with CLP undergo orthognathic surgery during their childhood for correction of skeletal asymmetries or pharyngoplasty with a pharyngeal flap to improve the quality of speech and velopharyngeal function. During orthognathic surgeries, nasotracheal intubation is performed under general anesthesia. In our case report, the patient had undergone palatoplasty and pharygoplasty previously. During the orthognathic surgery, a flexible fiberoptic bronchoscope-guided nasotracheal tube was inserted through the pharyngeal flap ostium; however, active bleeding occurred in the nasopharynx. Bleeding occurred because the flap was torn. After achieving hemostasis, the surgery was completed successfully. Thus, if a patient may show the potential for velopharyngeal port obstruction, nasotracheal intubation should be performed with utmost care.

• 대한두개안면성형외과학회지
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• 제21권1호
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• pp.22-26
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• 2020

Background: This study investigated the outcomes of pharyngeal flap surgery in Asian patients with velopharyngeal dysfunction (VPD), with a focus on postoperative improvements in speech articulation and complications. Additionally, this study explored whether the cause of VPD and the timing of surgery affected outcomes in terms of speech improvement. Methods: A retrospective review was conducted of the medical records of 72 Asian VPD patients who underwent pharyngeal flap surgery performed by a single surgeon from 1996 to 2014. Operative complications were analyzed for all 72 patients, and preoperative and postoperative speech articulation tests were compared for the subset of 43 patients in whom such testing was possible. The relationships of age at surgery and the cause of VPD with the extent of improvement in speech articulation were also investigated. Results: Nine of the 72 patients (13%) experienced wound-related complications. Furthermore, 34 patients (47%) reported persistent snoring lasting for over 3 months, and 16 (22%) reported snoring for over 1 year. Three patients (4%) underwent reoperation. Speech articulation scores significantly improved postoperatively across all groups. Younger age at surgery was associated with greater improvements in speech outcomes, but no significant relationship was found between the cause of VPD and the extent of the postoperative improvement in speech outcomes. Conclusion: Speech outcomes improved after pharyngeal surgery in Asian patients with VPD. Early surgery was associated with favorable speech outcomes, but no association was found between the cause of VPD and postoperative speech outcomes.

• Archives of Plastic Surgery
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• 제39권6호
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• pp.655-658
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• 2012

Squamous cell carcinoma infrequently occurs at the soft palate. Although various methods can be used for reconstruction of soft palate defects that occur after resecting squamous cell carcinoma, it is difficult to obtain satisfactory results from the perspective of the functional restoration of the soft palate. A combination of bilateral palatal mucomuscular flap for the oral side and superiorly based posterior pharyngeal flap for the nasal side were performed on two patients who were diagnosed with squamous cell carcinoma of the soft palate in order to reconstruct the soft palate defects after surgical resection. After surgery, the patients were followed-up for a mean period of 11 months. The flaps were well maintained in both patients. The donor site defects were epithelialized and completely recovered. Additionally, no recurrence of the primary sites was shown. Slight hyponasality was observed in the voice assessments that were conducted 6 months after surgery. No food regurgitation or aspiration was observed in the swallowing tests. We used a combination of bilateral palatal mucomuscular flap and superiorly based posterior pharyngeal flap to reconstruct the soft palate defects that occurred after resecting the squamous cell carcinomas. We reduced the donor site complications and achieved functionally satisfactory outcomes.

• 대한후두음성언어의학회지
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• 제8권1호
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• pp.69-74
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• 1997

과대비성의 수술적 치료에 있어서 인두측벽의 운동성이 수술 후 어느 정도 남아있는가와 측두문의 크기를 어느 정도 유지하는 것이 적당한가를 결정하는 것이 환자의 만족도를 높이고 좋은 결과를 얻는데 중요한 부분을 차지함을 알 수 있었다.