BACKGROUND

Velopharyngeal insufficiency (VPI) occurs when the velum and lateral and posterior pharyngeal walls fail to separate the oral cavity from the nasal cavity during speech and deglutination. For cases with small insufficiencies, posterior pharyngeal wall implants may be the solution instead of flap surgery.     In the present study, we evaluated the efficiency of using porous polyethylene implant to correct velopharyngeal insufficiency in adult patients.

            MATERIAL and METHODS

            Ten male patients with velopharyngeal insufficiency underwent posterior pharyngeal augmentation with porous polyethylene implant.The evaluations for VPI on all patients in the study included the following:

1. Speech evaluation of nasality and articulation was performed by speech pathologist author by using Multi Dimentional Voice Programme (MDVP).

2.Mirror test: Detecting nasal emission.

3.Nasopharyngoscopy: Direct visualization of the velopharyngeal sphincter during speech. The distance between lateral pharyngeal walls at rest and during phonation were measured, and the rate of the lateral pharyngeal wall movement to velopharyngeal gap was calculated.

R= a- b  × 100

     a

R: The rate of the pharyngeal wall movement (%)

a: The distance between lateral pharyngeal walls in the rest

b: The distance between lateral pharyngeal walls in the phonation

This value was used at determining the implant size during the operation.     

4.      Magnetic resonance imaging: Magnetic resonance imaging was taken in the sagittal, and axial planes at rest and during sustained ‘e’. The distance between posterior pharyngeal wall and velum was measured during phonation. Velopharyngeal orifices were drawn and the gap area was calculated in the axial views at rest and during sustained ‘e’.

            The evaluation methods for VPI were done preoperatively and 6 months after surgery, and the results were compared.  

At the operation the distance between the lateral pharyngeal walls were measured. Implant length was determined according to the rate of the lateral pharyngeal wall movement to the velopharyngeal gap calculated from nasopharyngoscopy.

L = D × (100-R)

           100

L= Implant length (mm)

D= The distance between the lateral pharyngeal walls measured in the operation.

R= The rate of the lateral pharyngeal wall movement

Implant height determined with 2 mm plus to the distance between velum and posterior pharyngeal wall calculated in the sagittal plane MRI images. 

The width of the all implants was approximately 10 mm.

The implant is inserted in the pocket prepared in the posterior pharyngeal wall.

RESULTS

According to preoperative speech evaluation, seven patients had severe and three patients had moderate hypernasal speech. Follow-up evaluations demonstrated that 7 patients had normal speech without hypernasal resonance. Two patients had mildly hypernasal speech, and one had moderate hypernasality.

While all of the patients had nasal escape on mirror test preoperatively, only two of them had postoperatively.

When the preoperative and the postoperative results of MDVP were analyzed, there was statistically significant improvement in all parameters (p < 0.05).The distance between posterior pharyngeal wall and velum during phonation observed preoperatively have been disappeared in the postoperative period in all of the patients` sagittal plane MRI.

In the axial views of MRI, velopharyngeal gap area calculated preoperatively was reduced postoperative period.

There were statistically significant differences between preoperative and postoperative velopharyngeal gap area in the axial views at rest and during phonation (p < 0.05).

CONCLUSION

We conclude that the posterior pharyngeal wall augmentation with porous polyethylene is an effective method in the adult patients for correction of mild velopharyngeal insufficiency.