Augmentation pharyngoplasty is a type of plastic surgery for the pharynx (soft tissue in the back of the mouth) when the tissue at the back of the mouth can not close properly. This is usually used to correct speech problems in children with a cleft palate. It can also be used to correct problems from tonsillectomy or due to degenerative diseases. After surgery, the patient has an easier time to say a certain sound, such as 'p' and 't', and the sound may have a less nasal sound.
In this operation, the posterior pharyngeal wall is moved forward, making it similar to the adenoid pad and closing a small gap that interferes with the obvious speech.
Some techniques have been used including: rearranging soft tissues, planting cartilage and injecting or implanting various types of synthetic materials: (Peterson-Falzone et al., 2001)
- Soft-tissue progression: Passavant (1862), seeks to advance the soft tissues of the pharyngeal posterior wall by braiding the two middle palate muscles in order to emulate the Passavant ridge. Then, he tried to make this ridge by folding the pharyngeal mucosal flap on himself. This type of surgery is best for patients with velopharyngeal defects. (Peterson-Falzone et al., 2001)
- Cartilage implants: ingredients, (usually from the patient's ribs), are implanted to make anterior projection on the pharyngeal wall. Most of the time, the success rate is low because the surgeon can not get a large enough sample of ribs to stay in place on the pharyngeal wall. Lately, some surgeons only perform this surgery in patients with openings as wide as 5 mm or less. Ten patients in this study no longer experienced hypernasality or audible nasal emissions. Other studies were conducted in the same situation (20 patients with 1-3 mm gaps), and had a much lower success rate. (Peterson-Falzone et al., 2001) Pg 320-321 Synthetic materials: synthetic materials used to add posterior pharyngeal wall include: Silicone (Blocksma, 1963), Teflon (Ward et al. 1966, Smith & McCabe, 1977), Proplast (Wolford et al. 1989), and collagen. Many of these procedures are abandoned because the results are unpredictable, there are postoperative complications or the Food and Drug Administration imposes restrictions. Overall this procedure is considered undesirable in the long run. (Peterson-Falzone et al., 2001)
Video Augmentation pharyngoplasty
Alternative
Pharyngeal flap surgery is a common alternative surgery.
Maps Augmentation pharyngoplasty
References
Bibliography
- Denny, Arlen D., Marks, Susan M., Oliff-Carineol, Susan (1993). Correction of velopharyngeal insufficiency with pharyngeal augmentation using autologous cartilage: Initial report. Cleft Palate-Craniofacial Journal, 30 (1), 46-54.
- Peterson-Falzone, Sally J., Hardin-Jones, Mary J., Karnell, Michael P. (2001). Cleft Palate Speech (3rd ed.). AS: Mosby.
- Witt, Peter D., O'Daniel, Thomas G., Marsh, Jeffrey L., Grames, Lynn M., Muntz, Harlan R., Pilgram, Thomas K. (1997). Surgical management of velolpharyngeal dysfunction: augmentation results of the posterior autosus posterior pharyngeal wall. Plastic and Reconstructive Surgery, 99 (5), 1287-1296.
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