Prospective evaluation of the outcome of velopharyngeal insufficiency therapy after simultaneous double z-plasty and sphincter pharyngoplasty.

OBJECTIVE One of the main goals in the management of cleft palate is to achieve a good quality of speech. The aim of the prospective study was to evaluate the effectiveness of therapy in patients with velopharyngeal insufficiency treated by simultaneously performed Furlow and Orticochea operations. PATIENTS AND METHODS From May 2007 to May 2008 we treated 14 consecutive patients (6 males and 8 females, mean age 14 years). The indications for surgery were based on nasofiberscopic examination, evaluation of speech quality, nasometry and morphology of the palate. The velopharyngeal closure was below 80% in all the patients; they had pronounced nasality and limited intelligibility of speech. All the palates were short. RESULTS The final outcome of treatment was based on the combined evaluation of 4 parameters: closure, speech intelligibility, nasality and the nasalance index. Ten patients achieved full recovery (71%), the remaining 4 had improved recovery (29%). CONCLUSION A 1-stage Furlow operation and sphincter pharyngoplasty are an effective modality in the therapy of velopharyngeal insufficiency. Indications for posterior pharyngeal flap pharyngoplasty should be limited to the cases in which a simultaneous Furlow operation and sphincter pharyngoplasty are not possible due to a deficit of the palatine tissue.