page_title: Velopharyngeal insufficiency
section_title: Sphincter palatoplasty
hierarchical_section_title: Velopharyngeal insufficiency / Treatment / Operation techniques / Sphincter palatoplasty
caption_attribution_description: English: Sphincterplasty
context_page_description: Velopharyngeal insufficiency is a disorder of structure that causes a failure of the velum to close against the posterior pharyngeal wall during speech in order to close off the nose during oral speech production. This is important because speech requires sound and airflow to be directed into the oral cavity for the production of all speech sound with the exception of nasal sounds. If complete closure does not occur during speech, this can cause hypernasality and/or audible nasal emission during speech. In addition, there may be inadequate airflow to produce most consonants, making them sound weak or omitted.
  The terms "velopharyngeal insufficiency" "velopharyngeal incompetence, "velopharyngeal inadequacy" and "velopharyngeal dysfunction" have often been used interchangeably, although they do not mean the same thing. "Velopharyngeal dysfunction" now refers to abnormality of the velopharyngeal valve, regardless of cause. Velopharyngeal insufficiency includes any structural defect of the velum or mechanical interference with closure. Causes include a history of
  cleft palate, adenoidectomy, irregular adenoids, cervical spine anomalies, or oral/pharyngeal tumor removal.
context_section_description: When the sphincter pharyngoplasty is used, both sides of the superior-based palatopharyngeal mucosa and muscle flaps are elevated. Because the distal parts (posterior tonsillar pillars, which the palatopharyngeal muscles are attached to) are sutured to the other side of the posterior wall, the pharyngeal port will become smaller. As a result, the tissue flaps cross each other, leading to a smaller port in the middle and a shorter distance between the palate and posterior pharyngeal wall.
  There are a few advantages with using this technique. First of all the procedure is relatively easy to execute. This makes the operation cheaper, also because of a reduced anesthesia time. Secondly the dynamic sphincter can be moved as result of a remaining neuromuscular innervation, which gives a better function of the velopharyngeal port. Finally there is a lower complication rate, although obstructive sleep apnoea syndrome (OSAS) is associated.
  Both techniques are used often, but there is no standard operation. Pharyngeal flap surgery is not better than sphincter palatoplasty. It is more upon the surgeon's experience, knowledge and preference which operation will be done. Also the patient’s age, and the size and nature of the velopharyngeal defect, contribute to which technique is used.
caption: Sphincterplasty
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