Correction of velopharyngeal insufficiency by pharyngeal augmentation using autologous cartilage: a preliminary report.

Twenty patients with velopharyngeal insufficiency (VPI) were treated with autologous costal bone or cartilage implants. Videofluoroscopy and videonasopharyngoscopy studies were used to identify candidates for the procedure. The specific size and shape of the gap as well as an appropriate location for the implant were determined in those patients for whom videonasopharyngoscopy was used. A piece of costal bone or cartilage was implanted into a preselected site in the posterior pharynx. Speech and voice evaluation were conducted preoperatively and 8 weeks postoperatively. Hypernasality and audible nasal emissions were completely eliminated in five patients. Four patients had no postoperative change in speech quality. In the remaining patients, improvement occurred without elimination of VPI. The use of costal bone was discontinued after the ninth patient. One infection occurred with complete resorption of the costal bone graft. Resorption has not been a problem with costal cartilage. No extrusion has occurred, and there have been no infections. Overall speech improvement in this group of children (80%) compared favorably with other reports on pharyngeal augmentation. Costal cartilage appears to be a superior choice for implant material.