Augmentation of the posterior pharyngeal wall with autologous tragal cartilage for management of velopharyngeal valve insufficiency in adults

Auris Nasus Larynx. 2021 Jun;48(3):428-433. doi: 10.1016/j.anl.2020.09.016. Epub 2020 Oct 13.

Abstract

Objective: The study aims to evaluate posterior pharyngeal wall augmentation using autologous tragal cartilage graft in adults with velopharyngeal valve insufficiency (VPI).

Methods: The study included 23 patients with VPI (grade I, II, III), with ages ranging from 19 to 45 years. Six patients had previously undergone simple palatoplasty for cleft palate, 8 patients had previously undergone adenotonsillectomy and 9 patients had previously undergone uvulopalatopharyngoplasty (UPPP). The procedure was done by implanting a piece of autologous tragal cartilage in the posterior pharyngeal wall. Patients were followed up for 24 months postoperatively. The evaluation of percent of speech intelligibility and grade of the closure of the velopharyngeal valve using video-nasopharyngoscopy was evaluated preoperatively and postoperatively.

Results: Highly statistically significant improvement in the grade of the closure of the velopharyngeal valve (P = 0.009) and percent of intelligibility (P = 0.001) was found after surgery. There were no postoperative airway obstruction or sleep apnea.

Conclusion: Augmentation of the posterior pharyngeal wall using tragal cartilage is an effective, safe and physiological surgical procedure in the management of VPI in adults who suffered hypernasality following palatal and oropharyngeal surgeries.

Keywords: Augmentation; Posterior pharyngeal wall; Speech intelligibility; Tragal cartilage; Velopharyngeal valve insufficiency.

MeSH terms

  • Adult
  • Ear Cartilage / transplantation*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pharynx / surgery*
  • Prospective Studies
  • Speech Intelligibility
  • Speech Therapy
  • Transplantation, Autologous
  • Velopharyngeal Insufficiency / surgery*
  • Young Adult