Pharyngoplasty

Overview

Pharyngoplasty is a surgical procedure designed to reshape the soft palate and the back of the throat to enhance speech and breathing. This surgery helps minimize the amount of air escaping through the nose during speech, which can improve the clarity of communication. It is commonly recommended for individuals with velopharyngeal insufficiency (VPI), a condition that leads to overly nasal-sounding speech and can make understanding difficult. Additionally, pharyngoplasty may be used to address sleep apnea in adults.

Types

Pharyngoplasty includes several types of procedures tailored to specific issues:

• Pharyngeal flap pharyngoplasty: To treat VPI, this procedure helps to close the gap between the palate and the throat, reducing the amount of air that escapes through the nose while speaking.
• Lateral pharyngoplasty: This procedure is used to treat obstructive sleep apnea (OSA) by widening the airway.
• Sphincter pharyngoplasty: Similar to the pharyngeal flap, this procedure also addresses VPI but through narrowing the opening between the throat and the nasal cavity.

Reasons for undergoing the procedure

People with velopharyngeal insufficiency (VPI) are often recommended with pharyngoplasty.  VPI is commonly caused by several conditions, such as:

• Cleft palate
• Sleep apnea
• Cerebral palsy
• Adenoidectomy
• Tonsillectomy
• Radiation treatment to the pharynx, or throat, which includes the middle throat part and the top throat section
• Genetic disorders such as DiGeorge syndrome (sometimes called velocardiofacial syndrome, or VCFS) and Down syndrome

About 1 in 1,700 babies are born with cleft palate, and approximately 1 in 3 children who have cleft palate surgery may develop VPI and need pharyngoplasty.

Risk

After pharyngoplasty for velopharyngeal insufficiency (VPI), some people might still have issues, such as sleep apnea or loud snoring.

If VPI continues or sleep apnea develops, a minor outpatient procedure can be done to adjust the throat openings: making them smaller for VPI or enlarging them for sleep apnea. While snoring often gets better with time, a sleep study might be recommended six months post-surgery to check for sleep apnea.

Before the procedure

To prepare for pharyngoplasty, it is important to closely follow the instructions given by the healthcare provider, such as:

• Stopping specific medications, vitamins, or herbal supplements
• Taking certain medications as prescribed
• Informing them of any allergies one might had

During the procedure

Pharyngoplasty can last up to two hours depending on the type being performed. All are done under general anesthesia, and steps may vary per procedure.

• Pharyngeal flap: This procedure addresses VPI by taking a flap of tissue from the back of the throat and attaching it to the palate with dissolvable stitches. It closes the gap between the palate and throat while leaving small openings for nasal breathing.
• Sphincter pharyngoplasty: Also for VPI, this surgery involves taking tissue flaps from behind each tonsil and stitching them across the back of the throat to narrow the space and prevent nasal air leakage during speech, with one small port for nasal breathing.
• Lateral pharyngoplasty: Used for sleep apnea, this surgery involves expanding the airway by removing and repositioning tissue in the palate and side of the throat and may include a tonsillectomy if the tonsils are present.

After the procedure

After pharyngoplasty, most patients stay in the hospital for one to three nights. In rare cases, about 1 in 20 patients may require a nasopharyngeal airway—a tube placed in the nose—to assist with breathing until the swelling subsides.

One might experience symptoms such as bleeding from the mouth or nose, nasal congestion, and sore throat or neck pain, which can make swallowing difficult. These side effects typically resolve on their own within a few days.

Outcome

During recovery period, it is important to monitor for potential signs of complications. Seek immediate medical attention when any of the following is experienced:

• Problems with sleeping, such as sleep apnea
• An infection, such as a fever or bad-smelling nasal or oral discharge
• Dehydration
• Decrease in appetite

It is also essential to follow specific instructions such as:

• Using over-the-counter (OTC) or prescription painkillers
• Using ice chips to soothe a sore throat
• Participating in speech therapy
• Sticking to a liquid or soft food diet
• Keeping the head elevated while resting
• Avoiding heavy lifting and physical activities
• Taking antibiotics

The success rates for pharyngoplasty depend on the type of surgery performed. Lateral pharyngoplasty improves sleep apnea symptoms by about 50%. Pharyngeal flap surgery is effective for treating velopharyngeal insufficiency (VPI) 80% to 90% of the time. Sphincter pharyngoplasty is somewhat less effective, with a success rate of 60% to 70% for treating VPI.

Generally, pharyngoplasty offers benefits such as better breathing, improved speech, and reduced sleep apnea symptoms.