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

Authors

Raina K. Patel, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Melanie Bakovic, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Erin Wolfe, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Artur Manasyan, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Valeria Mejia, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Asli Pekcan, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Marvee Turk, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Alyssa Valenti, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Mark M. Urata, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Jeffrey A. Hammoudeh, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.

Document Type

Journal Article

Publication Date

10-20-2025

Journal

Plastic and reconstructive surgery

DOI

10.1097/PRS.0000000000012548

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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). DISCUSSION: 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.

APA Citation

Patel, Raina K.; Bakovic, Melanie; Wolfe, Erin; Manasyan, Artur; Mejia, Valeria; Pekcan, Asli; Turk, Marvee; Valenti, Alyssa; Urata, Mark M.; and Hammoudeh, Jeffrey A., "Evaluating Surgical Outcomes: A Comparative Analysis of Two Techniques for Sphincter Pharyngoplasty" (2025). GW Authored Works. Paper 8257.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8257

Department

School of Medicine and Health Sciences Student Works