Definition and Overview
Pharyngolplasty is a surgical procedure performed on the pharynx, which refers to a group of soft tissues located at the back of the mouth and the nasal cavity, and above the oesophagus and trachea. This group of tissues is part of the digestive system as well as the respiratory system’s conducting zone along with the nose, trachea, bronchi, and bronchioles.
Pharyngolplasty is performed on children with orofacial clefts (especially a cleft palate) and adults suffering from obstructive sleep apnoea with the goal to improve functions such as breathing, speaking, and swallowing.
Who Should Undergo and Expected Results
As mentioned above, pharyngolplasty can be performed to treat cleft lip and/or cleft palate (also known as an orofacial cleft), a congenital abnormality due to the failure of the pharynx to close during foetal development. With a cleft palate, the roof of the mouth has an opening that leads directly into the nose, a condition that can lead to several problems, including difficulty in feeding, speech impediments, hearing problems, and the frequent occurrence of ear infections. As such, the procedure is typically performed during the early months of life, before the infant learns to speak.
In adults, pharyngolplasty can also be used to address sleep apnoea, a serious sleep disorder characterised by pauses in breathing that can last from a few seconds to minutes, making it a life-threatening condition. Symptoms include snoring loudly and feeling tired even after a full night’s sleep. People with sleep apnoea might feel extremely tired or moody during the daytime, have heart problems or high blood pressure, type 2 diabetes, liver problems, and a higher risk of experiencing complications during surgery or while taking certain medications. The spouses of individuals with sleep apnoea might also be deprived of slumber and rest.
In a lateral pharyngolplasty, the surgeon increases the size of the patient’s airway without adversely affecting normal functions such as breathing, swallowing, and speaking. This procedure is typically combined with a tonsillectomy, as well as the removal and repositioning of the tissues in the roof of the mouth and the side of the throat.
As for the expected results, children with cleft palates can have an easier time pronouncing certain sounds after the surgery, and their voices will have a less nasal sound. Adults with obstructive sleep apnoea, on the other hand, can expect to achieve relief from the symptoms and side effects of their condition.
How is the Procedure Performed?
The procedure is performed under general anaesthesia, which is administered in adults through an injection or IV, and a breathing mask in children. In the case of paediatric patients, an anesthetist who specialises in providing numbing drugs to babies and children will be called in. The patient will need to be asleep and unable to feel pain during the whole procedure.
Once the effects of the anaesthesia have taken effect, a tube is inserted into the trachea or the airway to assist breathing.
To treat a cleft palate, the surgeon will shape the tissue at the back of the throat using an operating microscope to form a barrier that will prevent air from escaping through the nose. The procedure takes around one to two hours. A cannula will be placed into a patient’s vein, which will be used to pass fluids into the patient’s system during and after the procedure.
In a lateral pharyngolplasty, the surgeon makes incisions on the tissues located on the sides of the tonsils. The surgeon will then remove some tissues from this area and suture the incisions closed. Tonsillectomy can also be performed along with this procedure to open up the patient’s airway. This procedure takes about an hour, and the patient will need to stay in the hospital for at least one night for close monitoring. Work and normal activities can be resumed within 10 to 14 days.
Possible Risks and Complications
Pharyngolplasty is a generally safe surgical procedure, but is linked to common risks and complications, which include:
- Infections, which are quite rare, especially because patients are given antibiotics during the procedure
- Difficulty swallowing
- Narrowing at the top of the throat
- Injuries to the teeth caused by medical instruments used to open the mouth
- Changes in speech
- Witt, Peter D., O’Daniel, Thomas G., Marsh, Jeffrey L., Grames, Lynn M., Muntz, Harlan R., Pilgram, Thomas K. (1997). Surgical management of velolpharyngeal Dysfunction: outcome analysis of autogenous posterior pharyngeal wall Augmentation. Plastic and Reconstructive Surgery, 99 (5), 1287-1296.