Posterior Pharyngeal Wall Augmentation with Acellular Dermis Implant for Velopharyngeal Insufficiency

Abstract

Objectives:

Review outcomes for children with velopharyngeal insufficiency (VPI) after posterior pharyngeal wall augmentation with an acellular dermis implant.

Methods:

Retrospective case series of children with VPI who underwent augmentation pharyngoplasty from 2002-2011 at a tertiary care children’s hospital. The posterior pharyngeal wall was augmented with rolled acellular dermis inserted in the subfascial plane. Pre- and postoperative nasometry, speech nasal endoscopy, and caretaker and clinician perceptual evaluation were reviewed.

Results:

Twenty-four children with VPI (average age 8.8 ± 4.0 yrs) who underwent augmentation pharyngoplasty were identified. The majority of these children had a small gap noticed on speech nasal endoscopy. Of the 24 children, 5 were lost to follow-up and were not assessed in the postoperative period. Average follow-up for the remaining 19 patients was 17.6±20.9 months. Fifteen of the 19 patients (79%) had some improvement in VPI symptoms as determined by clinical perceptual evaluation, but only 8 children (42%) demonstrated complete resolution after the operation. One implant extruded. No major complications related to the surgical procedure were identified.

Conclusions:

We present a novel technique to treat VPI using an acellular dermis implant to augment the pharyngeal wall. Although this approach does not successfully treat all children with VPI, no major complications were seen in this series. Vital tissue that may be used for future speech surgery is preserved if this treatment option fails.