In‐Office Injection Pharyngoplasty for Velopharyngeal Insufficiency After Oropharyngeal Cancer Treatment

Abstract

INTRODUCTION Velopharyngeal insufficiency (VPI) is the failure of the soft palate to the meet the posterior pharyngeal wall during speech and swallowing. This insufficiency can result in nasal speech sounds and nasal regurgitation during eating. Intraoral bolus pressure is created by sealing the nasopharynx during the oropharyngeal phase of swallowing. VPI is failure of complete velopharyngeal closure, resulting in a decreased intraoral bolus pressure and consequently bolus stasis. Oropharyngeal carcinoma treatment includes primary radiation or chemoradiation therapy; open or transoral surgery; and more recently, transoral robotic surgery. These treatments can result in an acquired VPI. Large oropharyngeal defects require surgical or prosthetic augmentation with obturators, including rotational flaps and free flap reconstruction. Smaller defects are generally left untreated. Injection pharyngoplasty is a well-described procedure for VPI in the pediatric population. This has been used as a primary treatment for mild cases or as an adjuvant procedure following cleft palate repair or sphincter pharyngoplasty. Injection pharyngoplasty displaces the posterior pharyngeal wall anteriorly to provide a contact point for the soft palate and allow adequate velopharyngeal closure. There are only a few reported cases of injection pharyngoplasty use in adults. However, to our knowledge there are no reports of injection pharyngoplasty performed in an office setting. This retrospective case series describes the procedure of in-office injection pharyngoplasty and its use in the treatment of acquired VPI after treatment of oropharyngeal carcinoma. METHODS