Preliminary Evaluation of Changes in Lateral Pharyngeal Wall Motion Following Secondary Palatoplasty for Velopharyngeal Dysfunction

Pharyngeal wall motion is a key component of velopharyngeal closure, essential for normal speech production. This study investigated changes in lateral pharyngeal wall motion in patients with cleft palate who required secondary surgery to correct velopharyngeal dysfunction. A retrospective review was conducted at a tertiary pediatric hospital, including 20 patients who underwent secondary procedures between 2015 and 2021. The procedures included (1) pharyngeal flap, (2) palatal re-repair with buccal flaps, and (3) palatal re-repair only. Lateral pharyngeal wall motion and speech outcomes were assessed preoperatively and postoperatively using measurements from videofluoroscopic imaging and a 4-point perceptual speech score, respectively. Twenty patients with complete assessments were included. Lateral wall motion increased in all patients after secondary palatoplasty, regardless of repair type. Postoperative lateral wall motion significantly improved compared with preoperative measurements (34% to 75%, P<0.001). Among the 3 techniques, postoperative lateral wall percent closure was equivalent (P=0.174). All patients undergoing pharyngeal flap, re-repair with buccal flaps, or re-repair only exhibited improvements in lateral pharyngeal wall closure. These findings of this retrospective review support the assessment of lateral pharyngeal wall motion during speech production both before and after secondary palatal surgery.