(0701) Postoperative Rates of Velopharyngeal Insufficiency With and Without Pharyngoplasty for Patients Undergoing Transoral Cancer Surgery

Introduction: Transoral resection can lead to acquired velopharyngeal insufficiency (VPI) resulting in incomplete separation of the nasal cavity and oral cavity during swallowing and speech. Pharyngoplasty can reduce rates of VPI with soft palate resections and is often performed by augmenting the soft palate with the uvula. In this study, we aim to investigate the immediate postoperative rates of VPI in patients who underwent transoral resection for oropharyngeal squamous cell carcinoma (OPSCC) of the tonsil with or without the addition of pharyngoplasty.

Methods: A retrospective review of all patients who underwent transoral resection for OPSCC of the palatine tonsils at a single institution between October 2019 and September 2023 was performed. All patients underwent a modified barium swallow study to assess dysphagia and swallow function after resection within a week after resection. Other variables included in the analysis were necessity for gastrostomy tube insertion in the immediate postoperative phase, incidents of bleeding from the surgical site, duration of hospitalization, as well as tongue weakness, thin liquid and pureed penetration and aspiration, and marginal mandibular weakness. Descriptive statistics and fisher's exact test or chi squared testing were used to analyze the data.

Results: In total, 89 patients were identified. All patients had a palatine tonsil primary oropharyngeal cancer. Of the total, 67 patients had a pharyngoplasty and 22 patients did not. Additionally, 32 patients who underwent pharyngoplasty had VPI, and 8 patients who did not have a pharyngoplasty had VPI. This difference was not significant (p > 0.05). Of patients in the pharyngoplasty group, 10 had severe or worse dysphagia while 2 patients in the non-pharyngoplasty group had severe or worse dysphagia which was not significantly different (p > 0.05). There was no significant difference (p > 0.05) between gastrostomy tube placement between the pharyngoplasty (6) and non-pharyngoplasty groups (2).

Conclusions: Pharyngoplasty does not improve immediate postoperative VPI in patients who are undergoing palatine tonsil oropharyngeal cancer resection.