Evaluating Surgical Outcomes: A Comparative Analysis of Two Techniques for Sphincter Pharyngoplasty.

Abstract

Sphincter pharyngoplasty (SP) is a well-established surgical strategy for correcting velopharyngeal insufficiency (VPI) after cleft palate repair. SP can be performed with flap inset in either an end-to-end (ETE) or overlapping (OL) pattern. In this study, we compare the relative efficacy of ETE versus OL inset in patients undergoing SP for VPI. A retrospective review was conducted of VPI patients who underwent SP at a major children's hospital between 2007 and 2023. Patient data collection included demographic characteristics, speech outcomes, and polysomnography results. Statistical analysis was performed using Mann-Whitney U and Chi-square tests. Ninety patients underwent SP, with 44 (49%) in the ETE group and 46 (51%) in the OL group. Patients with OL inset had better speech outcomes, with 56.5% achieving balanced resonance compared to 34.1% in the ETE group (p=0.033). ETE patients also had more compensatory speech errors (34.1% vs. 8.7%, p=0.003). OL inset patients had significantly higher rates of obstructive sleep apnea (OSA) and a higher apnea-hypopnea index (8.2 vs. 3.1, p=0.039). SP with OL inset is associated with improved speech outcomes but greater risk of OSA. The choice of inset pattern should be carefully considered to balance these considerations.