Creating a Superiorly Based Pharyngeal Flap: Is Prominence of C1 Superior Enough, and Will Adenoid Pad Be in the Way?
Background:. Positioning the pharyngeal flap base high along the posterior pharyngeal wall is essential for optimizing speech outcomes. Objective data on where to place the flap base are lacking. Further, adenoid tissue can restrict cephalad positioning of the flap. This study aimed to improve the d...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-06-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006797 |
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| author | Thomas J. Sitzman, MD, MPH Jessica L. Chee-Williams, MS Taylor D. Snodgrass, MS Imani R. Gilbert, MS Travis T. Tollefson, MD, MPH Davinder J. Singh, MD Jamie L. Perry, PhD |
| author_facet | Thomas J. Sitzman, MD, MPH Jessica L. Chee-Williams, MS Taylor D. Snodgrass, MS Imani R. Gilbert, MS Travis T. Tollefson, MD, MPH Davinder J. Singh, MD Jamie L. Perry, PhD |
| author_sort | Thomas J. Sitzman, MD, MPH |
| collection | DOAJ |
| description | Background:. Positioning the pharyngeal flap base high along the posterior pharyngeal wall is essential for optimizing speech outcomes. Objective data on where to place the flap base are lacking. Further, adenoid tissue can restrict cephalad positioning of the flap. This study aimed to improve the design of the pharyngeal flap by measuring the distance from the first cervical vertebrae (C1) to the palatal plane, and the adenoid depth in children undergoing evaluation for velopharyngeal insufficiency.
Methods:. This retrospective cross-sectional study analyzed magnetic resonance imaging (MRI) scans of the velopharynx and measured the distance between C1 and the palatal plane, and the adenoid depth at the level of the palatal plane in millimeters.
Results:. Thirty-four patients met the inclusion criteria. The mean age at the time of MRI was 7.4 years (range: 3.9–11.9 y). The anterior tubercle of C1 was below the palatal plane in 97% (n = 33) of patients. On average, this landmark was 10.5 mm (SD = 5.0) below the palatal plane. Adenoid tissue was present at the level of the palatal plane in 91% (n = 31) of patients.
Conclusions:. Positioning the pharyngeal flap base at C1 is too low to aid with velopharyngeal closure. Further, adenoid tissue is frequently present at the level of velopharyngeal closure, limiting superior positioning of the pharyngeal flap base. When this occurs, surgeons should consider adenoidectomy before pharyngeal flap surgery. Preoperative MRI may be beneficial for planning pharyngeal flap positioning relative to C1 and assessing adenoid tissue at the palatal plane. |
| format | Article |
| id | doaj-art-bd8a15a9ab6842279c6a31ed3a210bb0 |
| institution | Kabale University |
| issn | 2169-7574 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj-art-bd8a15a9ab6842279c6a31ed3a210bb02025-08-20T03:47:21ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742025-06-01136e679710.1097/GOX.0000000000006797202506000-00063Creating a Superiorly Based Pharyngeal Flap: Is Prominence of C1 Superior Enough, and Will Adenoid Pad Be in the Way?Thomas J. Sitzman, MD, MPH0Jessica L. Chee-Williams, MS1Taylor D. Snodgrass, MS2Imani R. Gilbert, MS3Travis T. Tollefson, MD, MPH4Davinder J. Singh, MD5Jamie L. Perry, PhD6From the * Division of Plastic Surgery, Center for Cleft and Craniofacial Care, Phoenix Children’s Hospital, Phoenix, AZFrom the * Division of Plastic Surgery, Center for Cleft and Craniofacial Care, Phoenix Children’s Hospital, Phoenix, AZ¶ Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC¶ Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC∥ Department of Facial Plastic and Reconstructive Surgery, University of California Davis, Sacramento, CA.From the * Division of Plastic Surgery, Center for Cleft and Craniofacial Care, Phoenix Children’s Hospital, Phoenix, AZ¶ Department of Communication Sciences and Disorders, East Carolina University, Greenville, NCBackground:. Positioning the pharyngeal flap base high along the posterior pharyngeal wall is essential for optimizing speech outcomes. Objective data on where to place the flap base are lacking. Further, adenoid tissue can restrict cephalad positioning of the flap. This study aimed to improve the design of the pharyngeal flap by measuring the distance from the first cervical vertebrae (C1) to the palatal plane, and the adenoid depth in children undergoing evaluation for velopharyngeal insufficiency. Methods:. This retrospective cross-sectional study analyzed magnetic resonance imaging (MRI) scans of the velopharynx and measured the distance between C1 and the palatal plane, and the adenoid depth at the level of the palatal plane in millimeters. Results:. Thirty-four patients met the inclusion criteria. The mean age at the time of MRI was 7.4 years (range: 3.9–11.9 y). The anterior tubercle of C1 was below the palatal plane in 97% (n = 33) of patients. On average, this landmark was 10.5 mm (SD = 5.0) below the palatal plane. Adenoid tissue was present at the level of the palatal plane in 91% (n = 31) of patients. Conclusions:. Positioning the pharyngeal flap base at C1 is too low to aid with velopharyngeal closure. Further, adenoid tissue is frequently present at the level of velopharyngeal closure, limiting superior positioning of the pharyngeal flap base. When this occurs, surgeons should consider adenoidectomy before pharyngeal flap surgery. Preoperative MRI may be beneficial for planning pharyngeal flap positioning relative to C1 and assessing adenoid tissue at the palatal plane.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006797 |
| spellingShingle | Thomas J. Sitzman, MD, MPH Jessica L. Chee-Williams, MS Taylor D. Snodgrass, MS Imani R. Gilbert, MS Travis T. Tollefson, MD, MPH Davinder J. Singh, MD Jamie L. Perry, PhD Creating a Superiorly Based Pharyngeal Flap: Is Prominence of C1 Superior Enough, and Will Adenoid Pad Be in the Way? Plastic and Reconstructive Surgery, Global Open |
| title | Creating a Superiorly Based Pharyngeal Flap: Is Prominence of C1 Superior Enough, and Will Adenoid Pad Be in the Way? |
| title_full | Creating a Superiorly Based Pharyngeal Flap: Is Prominence of C1 Superior Enough, and Will Adenoid Pad Be in the Way? |
| title_fullStr | Creating a Superiorly Based Pharyngeal Flap: Is Prominence of C1 Superior Enough, and Will Adenoid Pad Be in the Way? |
| title_full_unstemmed | Creating a Superiorly Based Pharyngeal Flap: Is Prominence of C1 Superior Enough, and Will Adenoid Pad Be in the Way? |
| title_short | Creating a Superiorly Based Pharyngeal Flap: Is Prominence of C1 Superior Enough, and Will Adenoid Pad Be in the Way? |
| title_sort | creating a superiorly based pharyngeal flap is prominence of c1 superior enough and will adenoid pad be in the way |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006797 |
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