What is a Pharyngoplasty or Pharyngeal Flap Procedure?
Children with a repaired cleft palate may have a resulting condition referred to as "VPI" (Velopharyngeal Incompetence). This means that too much air escapes through the nose during speech, resulting in a nasal sounding speech. This occurs because the repaired soft palate is too short or does not move adequately.
A surgical operation called a pharyngoplasty or pharyngeal flap procedure improves the function of the soft palate. In this operation, some of the tissue from the palate and the back of the throat are repositioned to help close off the escape of air through the nose.
The goal of a pharyngoplasty is successful communication for a child with cleft lip and palate. The speech pathologist regularly monitors the development of using and understanding language and the development of speech abilities including pronunciation of words (articulation), the sound of the voice and the amount of nasality during speech. When necessary, recommendations for speech therapy are made based on the child's specific needs.
List of Physicians Who Perform Pharyngoplasty
For details about education, experience, and specialty in this clinical area, please visit these physician profile pages:
Diagnostic Procedures for VPI
This condition is diagnosed primarily by the trained ear of the speech pathologist. However, special diagnostic procedures such as nasoendoscopy, nasometry and videofluoroscopy of speech may be required to directly visualize the soft palate during speech. This helps in directing the type of intervention which is the most appropriate.
Nasoendoscopy is a test to determine the motion of the soft palate, the back, and side walls of the throat, the back of the tongue, and the voice box during speech. This is done by passing a small tube through one nostril and into the throat. This scope ("Nasoendoscope") is connected to a light, which shines through the tube and into the throat. A camera is attached to the scope, and the study is recorded on a VCR for later review. The patient is asked to say several sounds, words and sentences in order to see how the muscles of the throat work. To allow the tube to pass without pain through the nose and into the throat, a numbing medication is given through a dropper and on a Q-tip. No shots or needles are ever used. The nasoendoscopy is done by the speech pathologist working with the plastic surgeon.
Nasometry is a test that measures the amount of air that comes out of the nose and the mouth while talking. This test helps find out if someone has too much or too little air coming out of the nose while talking. During the test, the patient wears a special hat that has a divider, which rests on the upper lip. The divider has two microphones, which measure the sound waves when talking. The sound waves are sent into a computer, which tests the signal. The computer then gives numbers which are used to figure out who much nasality your child has. No shots or needles are ever used. The nasometry is done by a speech pathologist.
This is a moving picture x-ray of the head and neck which focuses on the movement of the soft palate (the soft part of the roof of the mouth) and the back and side walls of the throat. VPI is done at some time before any surgery is planned to correct nasal speech problems. It is conducted in the Motts Children's Hospital Pediatric Radiology department by a speech pathologist and a radiologist (x-ray doctor). The patient is asked to make sounds, words, and sentences. The study is recorded on videotape. In order to see the palate, a liquid material called barium is put through the nose with a syringe (without the needle). No shots or needles are ever used.
How to Prepare for the Procedure
There are no specific preparations necessary; however, your child should not eat for one hour before videofluoroscopy. These procedures are completed on an out-patient basis at the "Department of Pediatric Physical Medicine and Rehabilitation" on the 2nd floor of Mott Children's Hospital. It may be helpful to explain the procedure to your child to alleviate anxiety or fear. Also, you can assure your child that there are no shots with this procedure.
After Your Child's Procedure
Click here for information about how to care for your child after the surgery and what to expect during the recovery period. It is very important that you follow your surgeon's instructions. Also, it is important that you attend all follow-up appointments scheduled so that your speech pathologist and surgeon can assess your child's long-term results and answer any questions or concerns you may have.