Research Article| Volume 65, ISSUE 7, P864-868, July 2012

Pharyngeal flap versus sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency: A meta-analysis

Published:March 29, 2012DOI:



      Velopharyngeal insufficiency (VPI) has been reported in 5–20% of patients following cleft palate repair. Since VPI can limit communication, determining which operative procedure leads to the greatest improvement is of utmost importance. Since there is no consensus, this meta-analysis aims to determine which procedure results in the most significant resolution of VPI.


      Two independent assessors undertook a literature review for articles that compare procedures aimed at treating VPI. Study quality was determined using validated scales. Level of agreement was assessed using intra-class coalition coefficient analysis. The heterogeneity between studies was evaluated using I2 and Cochran’s Q-statistic. Random effect model analysis and forest plots were used to report a pooled odds ratio (OR) and 95% confidence intervals (CI) for treatment effect. A p-value of 0.05 was considered for statistical significance.


      Two randomised controlled trials (RCTs) comparing pharyngeal flap to sphincter pharyngoplasty were obtained. A total of 133 patients were included, with follow-ups at 3–4 months. The pooled OR was determined to be 2.95 (95% CI: 0.66–13.23) in favour of the pharyngeal flap.


      Based on these RCTs, which currently compose the highest quality data that compares pharyngeal flap versus pharyngoplasty, the pooled treatment effect suggests a possible trend favouring pharyngeal flap.


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        • Johns D.F.
        • Rohrich R.J.
        • Awada M.
        Velopharyngeal incompetence: a guide for clinical evaluation.
        Plast Reconstr Surg. 2003; 112: 1890-1897
        • Sullivan S.R.
        • Marrinan E.M.
        • Mulliken J.B.
        Pharyngeal flap outcomes in nonsyndromic children with repaired cleft palate and velopharyngeal insufficiency.
        Plast Reconstr Surg. 2010; 125: 290-298
        • Marsh J.L.
        The evaluation and management of velopharyngeal dysfunction.
        Clin Plast Surg. 2004; 31: 261-269
        • Sloan G.M.
        Posterior pharyngeal flap and sphincter pharyngoplasty: the state of the art.
        Cleft Palate Craniofac J. 2000; 37: 112-122
        • Witt P.
        • Wahlen J.
        • Marsh J.L.
        • Grames L.M.
        • Pilgram T.K.
        The effect of surgeon experience on velopharyngeal functional outcome following palatoplasty: is there a learning curve?.
        Plast Reconstr Surg. 1998; 102: 1375-1384
        • Kirschner R.E.
        • Randall P.
        • Wang P.
        • et al.
        Cleft palate repair at 3 to 7 months of age.
        Plast Reconstr Surg. 2000; 105: 2127-2132
        • Marrinan E.M.
        • LaBrie R.A.
        • Mulliken J.B.
        Velopharyngeal function in nonsyndromic cleft palate: relevance of surgical technique, age at repair, and cleft type.
        Cleft Palate Craniofac J. 1998; 35: 95-100
        • Peat B.G.
        • Albery E.H.
        • Jones K.
        • Pigott R.W.
        Tailoring velopharyngeal surgery: the influence of etiology and type of operation.
        Plast Reconstr Surg. 1994; 93: 948-953
        • Shprintzen R.J.
        • Lewin M.L.
        • Croft C.B.
        • et al.
        A comprehensive study of pharyngeal flap surgery: Tailor made flaps.
        Cleft Palate J. 1979; 16: 46-55
        • Nasser M.
        • Fedorowicz Z.
        • Newton J.T.
        • Nouri M.
        Interventions for the management of submucous cleft palate.
        Cochrane Database Syst Rev. 2008; : CD006703
        • Detsky A.S.
        • Naylor C.D.
        • O’Rourke K.
        • McGeer A.J.
        • L’Abbé K.A.
        Incorporating variations in the quality of individual randomized trials into meta-analysis.
        J Clin Epi. 1992; 45: 255-265
        • Slim K.
        • Nini E.
        • Forestier D.
        • et al.
        Methodological index for non-randomized studies (minors): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Abyholm F.
        • D’Antonio L.
        • Davidson Ward S.L.
        • et al.
        Pharyngeal flap and sphincterplasty for velopharyngeal insufficiency have equal outcome at 1 year postoperatively: results of a randomized trial.
        Cleft Palate Craniofac J. 2005; 42: 501-511
        • Ysunza A.
        • Pamplona C.
        • Ramírez E.
        • et al.
        Velopharyngeal surgery: a prospective randomized study of pharyngeal flaps and sphincter pharyngoplasties.
        Plast Reconstr Surg. 2002; 110: 1401-1407
        • Ysunza A.
        • Pamplona M.C.
        • Molina F.
        • et al.
        Surgery for speech in cleft palate patients.
        Int J Pediatr Otorhinolaryngol. 2004; 68: 1499-1505
        • Tramèr M.R.
        • Reynolds D.J.M.
        • Moore R.A.
        • McQuay H.J.
        Impact of covert duplicate publication on meta-analysis: a case study.
        Br Med J. 1997; 315: 635-640
        • de Serres L.M.
        • Deleyiannis F.W.
        • Eblen L.E.
        • et al.
        Results with sphincter pharyngoplasty and pharyngeal flap.
        Int J Pediatr Otorhinolaryngol. 1999; 48: 17-25
        • Pensler J.M.
        • Reich D.S.
        A comparison of speech results after the pharyngeal flap and the dynamic sphincteroplasty procedures.
        Ann Plast Surg. 1991; 26: 441-443
        • Williams H.
        • Woolhouse F.
        Comparison of speech improvement in cases of cleft palate after two methods of pharyngoplasty.
        Plast Reconstr Surg. 1962; 30: 36-42
        • Witt P.D.
        • Myckatyn T.
        • Marsh J.L.
        Salvaging the failed pharyngoplasty: Intervention outcome.
        Cleft Palate Craniofac J. 1998; 35: 447-453