PURPOSE: Velopharyngeal insufficiency may be successfully corrected with the augmentation of the posterior pharynx. This study examines a five decade long experience in augmentation of the posterior pharyngeal wall.

METHODS: A retrospective review was performed of all posterior pharyngeal augmentations performed at our institution between 1954 to present. 98 patients received posterior pharyngeal augmentation with 105 implants placed. Ages ranged from 5 to 33 years. Gap size ranged from 2mm to 10mm. All patients were judged to have clearly nasal speech preoperatively. Follow-up averaged 21 months (range: 1-51 months).

RESULTS: In 98 patients there were 12 failures (88% success). Of 105 implants placed 13 were removed (88% success). Secondary augmentation of patients with failures was successfully performed in 5 patients to yield an overall success rate of 92%. Highest extrusion rates were seen in silicone block and rolled Gortex (33%). The most common material used was a Dacron coated silicone gel filled pillow which yielded 90% success (80/89). Speech results were available for 77 patients with 76 patients showing improvement (99%).

CONCLUSIONS: Augmentation of the posterior pharyngeal wall is a highly effective technique to improve speech in patients with velopharyngeal insufficiency. Implants are well tolerated and yield excellent speech improvement