Posterior Pharyngeal Wall Augmentation: An Alternative Approach for Managing Nasal Regurgitation in Velopharyngeal Incompetence

Abstract

This study examines the management of nasal regurgitation associated with velopharyngeal incompetence (VPI), a condition primarily recognized for its effects on speech. While significant surgical interventions are available for speech-related symptoms, nasal regurgitation often goes unnoticed. We assessed the effectiveness of posterior pharyngeal wall augmentation (PPWA) using costal cartilage as a treatment for patients experiencing nasal regurgitation due to VPI. A retrospective review was conducted at Cleft and Craniofacial South Australia over the past 5 years. Patients underwent simultaneous nasendoscopy and lateral videofluoroscopy evaluations. Our focus was on those suffering from nasal regurgitation who received PPWA. Among the 20 patients treated with PPWA, 8 specifically indicated nasal regurgitation. Five had regurgitation as their only symptom, while 3 had additional speech-related concerns. All patients noted a significant improvement in regurgitation symptoms postoperatively, along with an elevation of the posterior pharyngeal wall. Notably, no complications, such as graft exposure, were observed. The results indicate that PPWA is another effective surgical intervention for managing nasal regurgitation in VPI patients. This study promotes a multidisciplinary approach that combines treatment for both speech and nasal regurgitation, ultimately enhancing patient quality of life.