Unilateral Moore Pharyngoplasty in the Treatment of Unilateral or Asymmetric Velopharyngeal Incompetence

Abstract

Objective

To describe the use of a unilateral modification of the Moore pharyngoplasty in the treatment of unilateral or asymmetric velopharyngeal incompetence (VPI) and analyze the results in a consecutive series of patients operated on by a single surgeon.

Design

Blind assessment of randomized speech and nasendoscopy recordings.

Setting

A two-site tertiary referral cleft unit.

Patients

Eighteen consecutive patients with asymmetrical or unilateral VPI of varying etiology.

Interventions

A unilateral Moore pharyngoplasty was performed in all patients. Three patients underwent radical dissection and retropositioning of the velar muscles at the same time as the unilateral Moore pharyngoplasty.

Main Outcome Measures

Pre- and postoperative nasality and nasal airflow using the CAPS score, assessment of nasendoscopy recordings, and the rate of further surgery.

Results

There was a significant improvement in hypernasality (p = .014). There was a highly significant decrease in the size of the velopharyngeal gap on the side on which the Moore pharyngoplasty was performed (p = .004) as well as a highly significant decrease in the total gap size (p = .003). The Moore flap was effective in obliterating the lateral pharyngeal recess in 11 of 12 patients (p = .004). Three patients required further velopharyngeal surgery.

Conclusions

In appropriately selected patients, a unilateral Moore pharyngoplasty is a safe and effective treatment for unilateral or asymmetric VPI. If indicated, a radical dissection and retropositioning of the velar muscles may be combined with a Moore pharyngoplasty.