Effectiveness of Pharyngeal Bulb-Obturator Prosthesis for Patients with Velopharyngeal Insufficiency after Palatoplasty

Introduction: Velopharyngeal insufficiency treatment by bulb-obturator prosthesis has proved to be significantly effective. However, predictive factors associated to such successful therapy have not been properly investigated.

Objective: To evaluate the effectiveness of the obturator prosthesis for the management of patients with hypernasality.

Method: Noncontrolled clinical trial, which included 20 cleft palate patients previously submitted to palatoplasty. Bulb-obturator prosthetic therapy was then indicated. The appliances were, at first, manufactured upon cast models, which were obtained after alginate or silicone impression. Posteriorly, the bulb was positioned and adapted to the velopharyngeal sphincter, according to nasofibroscopic examination. The patient returned after 15 days, when parameters related to adaptation, nasal air emission, and self-perceived voice improvement were examined.

Results: There was a significant decrease in the nasal air passage reports after bulb installation. Most of the study sample reported satisfactory adaptation to the obturator prosthesis, as well as relevant voice improvement after the bulb insertion. Such observation was significantly related to the absence of nasal air emission, but it was not associated to the velopharyngeal sphincter closure pattern at baseline.

Conclusions: The results from this study demonstrated that the proposed technique proved to be an effective velopharyngeal therapeutic approach.

Keywords: Velopharyngeal insufficiency, palatal obturators, laryngoscopy.