Comparison of resonance outcomes after pharyngeal flap and Furlow double-opposing Z-plasty for surgical management of velopharyngeal incompetence

Objective: The purpose of this study was to test the hypothesis that no significant difference exists in the speech outcomes between patients with severe velopharyngeal incompetence (VPI) who receive a pharyngeal flap and patients with less severe VPI who receive a Z-plasty for management of VPI. Design: This retrospective study from 1993 to 2002 included a review of pre-and postoperative perceptual speech and resonance assessments of patients with marginal VPI who received a Furlow double-opposing Z-plasty and patients with VPI who received a pharyngeal flap. Setting: All patients had surgical management of VPI at the Cleft Palate-Craniofacial Clinic at University of Iowa Hospitals and Clinics. Results: Both groups benefited from surgery with significant reduction in perceived hypernasality (p < .001). Comparison of postoperative assessments indicated no difference between the groups in hypernasality or hyponasality ratings. Neither group had a significant increase in hyponasality. Conclusion: Both pharyngeal flap and double-opposing Z-plasty proved equally effective at reducing hypernasality when the selection of the surgical procedures was based on preoperative ratings of perceived hypernasality and evaluation of velopharyngeal physiology. Severity of the VPI is an important factor when considering surgical management of VPI. Thorough preoperative evaluations of patients with VPI are essential in appropriate treatment planning.