1. Surgical Management of VPI Ahmed Nawres Hilla General Teaching Hospital

2. VP dysfunction clinic

3. Multiview Video fluoroscopy flexible Nasal endoscopy.

4. Nasal Endoscopy

8. Videofluoroscopy

11. Implementation of findings of video fluoroscopy and nasal endoscopy: Palatal knee anteriorly displaced -------> Re repair of the palate with retro positioning of levator mechanism. Palatal knee weak or absent (poor palatal movement / good lateral wall movement ) --------> superior pharyngeal flap. Poor lateral wall movement on AP view ------ sphincter pharyngoplasty. Poor movement all-around sphincter (little muscular activity in any area) ------- sphincter pharyngoplasty.

12. Surgical Management of VPI 1:Cleft palate re repair with retro positioning of levator mechanism 2:Pharyngeal flap (Hogan) 3:Sphincter pharyngoplasty(Hynes, Jackson – Orticochea)

15. Hynes Pharyngoplasty

17. Advantages of sphincter pharyngoplasty : §Can be performed rapidly §It is ideal when there is poor medial excursion of the lateral pharyngeal walls and a short AP component of velar competency. §Achieves both static and dynamic reduction in the VP port. §There is little or no scar tissue around the central opening, thus the size changes very little. §Little or no sleep apnea §Secondary adjustment of the sphincter is quite feasible, and simple to perform (ie allowing revision) through re elevating the flaps and adjusting the tightness of the sphincter.

18. THANK YOU