Pharyngoplasty

What is pharyngoplasty?

Pharyngoplasty is a surgical procedure to change the shape and function of tissue in the soft palate (velum) in the roof of your mouth and the back of your throat (pharynx). When done for speech, the procedure decreases the amount of air flowing out your nose when you talk. Your healthcare provider might suggest pharyngoplasty if you have intensely nasal-sounding speech (hypernasality) that can be difficult for people to understand. Children and adults with this problem, called velopharyngeal insufficiency (VPI), may benefit from pharyngoplasty.

In addition, a different type of pharyngoplasty can be done to address sleep apnea in adults.

When is pharyngoplasty done?

The surgery most commonly helps children born with a cleft palate (an opening in the roof of their mouth). This birth defect affects approximately 1 in 1,700 babies and is the leading cause of VPI. But adults can also have VPI. An estimated 1 in 3 children who have surgery to correct a cleft palate develop VPI and need pharyngoplasty.

Other causes of VPI in children and adults that may require pharyngoplasty include:

• Cerebral palsy.
• Genetic conditions like Down syndrome and DiGeorge syndrome (also known as velocardiofacial syndrome or VCFS).
• Radiation therapy to your pharynx (throat), including your nasopharynx (top throat section) and oropharynx (middle throat section).
• Removal of adenoids (adenoidectomy) or tonsils (tonsillectomy).
• Stroke.
• Tumors in your brain (brain cancer) or palate.

Healthcare providers also perform pharyngoplasty to treat adults who have sleep apnea that doesn’t improve with other therapies.

What are the different types of pharyngoplasty?

The different types of pharyngoplasty include:

• Lateral pharyngoplasty to treat sleep apnea by expanding your airway.
• Pharyngeal flap and sphincter pharyngoplasty to treat VPI by narrowing the opening to your throat.

What happens before pharyngoplasty?

You should follow your healthcare provider’s instructions to prepare yourself or your child for pharyngoplasty. These instructions may include stopping certain medications, vitamins or herbal supplements.

What takes place during pharyngoplasty?

All pharyngoplasty surgeries take place under general anesthesia, which means you or your child sleep through the procedure. Depending on the procedure, surgery may take up to two hours.

Pharyngoplasty steps vary depending on the type of procedure.

• Lateral pharyngoplasty: This surgery for sleep apnea expands your airway to improve breathing. It involves removing and repositioning tissue in your palate and the side of your throat (lateral pharynx). If you still have your tonsils, you may also get a tonsillectomy.
• Pharyngeal flap: This procedure to treat VPI involves taking a flap of tissue from the back of your throat and suturing it to your palate with dissolvable stitches. This repositioned tissue closes the gap between your palate and throat. Two small openings (called lateral ports) on each side of the flap allow you to breathe through your nose.
• Sphincter pharyngoplasty: During this procedure for VPI, your provider takes a flap of tissue from behind each tonsil. They use dissolvable stitches to suture the flaps into place across the back of your throat. The repositioned tissue narrows the space behind your palate and keeps air from leaking through your nose when you talk. One small opening (port) in the tissue allows you to breathe through your nose.

What happens after pharyngoplasty?

Most people stay in the hospital for one to three nights after pharyngoplasty. You or your child may experience:

• Bloody discharge from your mouth or nose.
• Nasal congestion (stuffy nose).
• Sore throat and neck pain, which can make it difficult to swallow.

These side effects of pharyngoplasty often resolve on their own in a few days. In rare instances (about 1 in 20), you may need a tube in your nose (nasopharyngeal airway) to help you breathe until the swelling goes down.

What are the benefits of pharyngoplasty?

Benefits of pharyngoplasty include:

• Better breathing.
• Improved speech.
• Reduced sleep apnea symptoms.

What are the risks of pharyngoplasty?

VPI can sometimes persist after a pharyngoplasty. Some people who get surgery to treat VPI develop loud snoring and sleep apnea. Snoring often improves over time. Your healthcare provider may recommend a sleep study (polysomnography) six months after surgery to check for signs of sleep apnea.

If VPI persists or sleep apnea occurs, your healthcare provider may perform a minor outpatient procedure. To treat VPI, they make the openings (ports) in your throat tissue smaller. They enlarge the ports to treat sleep apnea.

How long is the recovery from pharyngoplasty?

The recovery time after pharyngoplasty varies. You or your child should plan to miss a week of school or work to recover.

You should follow your healthcare provider’s recovery instructions, which may include:

• Elevating your head when sleeping or lying down.
• Following a liquid diet or soft food diet for one to three weeks.
• Not lifting anything heavy or participating in physical activities for a specific time.
• Taking antibiotics to prevent infection.
• Taking prescription or over-the-counter (OTC) pain relievers.
• Participating in speech therapy.
• Sucking on ice chips to ease a sore throat.

What is the success rate of pharyngoplasty?

Success rates for pharyngoplasty vary depending on the type:

• Lateral pharyngoplasty reduces sleep apnea symptoms by 50%.
• Pharyngeal flap surgery is 80% to 90% effective at treating VPI.
• Sphincter pharyngoplasty is 60% to 70% effective at treating VPI.

When should I see my healthcare provider?

You should call your healthcare provider if you or your child experiences signs of:

• Dehydration or loss of appetite.
• Infection, like fever or foul-smelling discharge from your nose or mouth.
• Sleep difficulties, including sleep apnea.