Pharyngeal Flaps versus Sphincter Pharyngeoplasty for Velopharyngeal Insufficiency in Cleft Palate Patients; Meta-Analysis.

Background: Insufficient function of the velum, lateral, and posterior pharyngeal walls cause velopharyngeal insufficiency (VPI), which is defined by an inability to properly separate the oral cavity from the nasal cavity. This condition is common, especially in people with cleft palates, where 20–30% of those with or without cleft lip may develop VPI after having their palatal repair, frequently as a result of insufficient velar length. VPI is substantially more likely in those with cleft palate, a congenital disorder characterized by an inadequate roof of the mouth. There are several different causes of VPI, including as acquired deficiencies, lymphoid tissue abnormalities (such as tonsils and adenoids), and congenital malformations. A history of overt or submucous cleft palate is the main contributor to VPI. When basic physiological functions including breathing, eating, and speaking are interfered with, symptoms of VPI result. The individual's general quality of life may be impacted as a result of communication problems and diminished speech comprehension. Although clinical evaluation is also an option, the best way to determine the health of the velopharyngeal sphincter is to combine videonasopharyngoscopy (VNP) with multi-view videofluoroscopy (MMVF). In order to restore appropriate function, specifically to reestablish the seal between the nasopharynx and oropharynx during speaking, surgical intervention is essential. The two main surgical procedures used to treat VPI are sphincter pharyngoplasty and pharyngeal flap.
Objective: In order to select the best method for individuals undergoing this surgery, the study will carefully examine and document the results and potential side effects of each technique.
Patients and Procedures: The study used the procedures stated in the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement to carry out this review. The PRISMA checklist and the procedures used were described elsewhere. The relevant research papers that were chosen covered information from January 2000 to January 2022. Pairwise meta-analyses of results were performed using Comprehensive Meta-Analysis software (CMA version 3.9). To assess the efficacy of pharyngeal flaps and sphincter pharyngoplasty as surgical therapies for velopharyngeal insufficiency in cleft palate patients, odds ratios (OR) and risk ratios (RR) with corresponding 95% confidence intervals (CI) were determined. Only the most recent papers were used for qualitative analysis in cases where institutions have published duplicate trials.
Results: When velopharyngeal insufficiency in patients with cleft palate was treated with sphincter pharyngoplasty, children aged 2 to 5 years had a significantly higher double risk ratio than those who underwent pharyngeal flap surgery [Risk ratio (RR) = 2.092, 95% CI (1.266-3.457), p-value=0.004]. Because there was no heterogeneity, as shown by I2=19.69 and P-value=0.291, the fixed model was used.
In conclusion, pharyngeal flap surgery was statistically effective than sphincter pharyngoplasty surgery at treating velopharyngeal insufficiency in people with cleft palate. Furthermore, pharyngeal flap surgery patients showed greater statistically significant decreases in hypernasality and resonance than sphincter pharyngoplasty patients. Although nasal obstruction following pharyngeal flap surgery was less severe than after sphincter pharyngoplasty, this difference did not produce a noteworthy result. Similar to how snoring was less common after pharyngeal flap surgery than after sphincter pharyngoplasty, this difference was not statistically significant. Notably, pharyngeal flap surgeries for treating velopharyngeal insufficiency were shown to have lower rate s of nasal emission and consonant correctness (12% and 13.6%, respectively).