Teflon Injection Pharyngoplasty

Abstract

Velopharyngeal competency is essential for normal speech and degluti— tion. Failure of this valve to function properly may be the result of an unoperated cleft palate or a cleft palate which has been repaired but which is too short for adequate closure. This causes nasal emission of air with resultant hypernasal speech. Velopharyngeal insufl'iciency may also be caused by paresis of the palatal and pharyngeal muscles, a congenitally short velum, a submucous cleft, or an acquired palatal defect. Many procedures have been utilized in the past to correct velopharyn-geal insufficiency. Obturators, posterior pharyngeal flaps, and naso-pharyngeal implants have been attempted. The implantation or injection of a foreign material into the submucosa of the retropharynx has long been an. intriguing solution to the problem. As early as 1902, Eck-stein (3) reported the injection of parafiin into the nasopharynx with apparent good results. The procedure was abandoned when migration of the implant resulted in mediastinitis. Later, the implantation of fascia, bone dust, and cartilage was used. Recently, Blocksma (2) has employed silicone rubber. All of these substances have certain disadvantages and the ideal implant material has yet to be tried and proved. A suitable substance should be finely dispersed in a harmless vehicle in order to be injectable, well tolerated by the tissues, and not resorbed in time (1). Teflon1 powder mixed with glycerine appears to be most suitable and complies with the above criteria. Teflon has been utilized with great success in the treatment of the paralyzed vocal cord. Arnold (1) and Lewy (6) reported dramatic res— toration of vocal function by the injection of the Teflon paste into the paralyzed vocal cord. Ward and Wepman (.9) injected Teflon into the posterior nasopharynx of cats and found the implant material well tol— erated and the tissue response minimal. In 1964, Lewy (7) injected Teflon into one patient with neurogenic velopharyngeal incompetence and The authors are associated with the