Endoscopic-assisted sphincter pharyngoplasty (EASP).

OBJECTIVES: Sphincter pharyngoplasty operation was designed for the treatment of velopharyngeal insufficiency via a transoral route. Few investigators used palatal stretching sutures or palatal splitting procedures (which may affect the performance of the palate) to overcome the problem of difficult visualization. The purpose of this study is to present and evaluate the role of intraoperative nasoendoscopy during sphincter pharyngoplasty. Although Vadodaria et al. (2004) (in a cadaver study) used the endoscope to perform SP operation, this study (to our knowledge) is the first report of intraoperative nasoendoscopy in sphincter pharyngoplasty.

SUBJECTS AND METHODS: This prospective study was conducted at ORL-HN Department, Zagazig University Hospitals, Zagazig University, Egypt. Seven patients with persistent postoperative hypernasality were enrolled in this work. They were prepared by head and neck physical examination and phonetic evaluation. Patients were subjected to treatment by endoscopic-assisted sphincter pharyngoplasty, a procedure that was designed to combine both a transoral and a transnasal routes via the aid of nasoendoscope. Postoperative nasoendoscopic and phonetic assessment was done for all of the patients.

RESULTS: The procedure is easily conducted, done by available instruments with no extra burden over patients or hospitals. The procedure insured an under vision and well controlled steps. No major complications were recorded. Good speech outcome results were reported.

CONCLUSION: Endoscopic-assisted sphincter pharyngoplasty is a new role the nasoendoscopy can play. The study demonstrates the feasibility of endoscopic assistance in sphincter pharyngoplasty, with the advantage of improved visualization of a traditionally difficult-to-expose area. There was neither increased risk to the patients nor added cost to the procedure since only widely-available instrumentation was used. The technique lessened the need for palatal stretching or splitting during the procedure.