Flexibility in Surgical Planning for Velopharyngeal Incompetence

Abstract

An effective velopharyngeal mechanism can be restored by several techniques: surgical reconstruction, speech training, prosthodontic techniques , or any combination of the three. However, criteria for selection of an appropriate therapeutic program are generally lacking and should be established. Many surgical procedures are described. Palate pushbacks, pharyngo-plasties and pharyngopalatal flaps have many variations and combina— tions. They are designed to alter the spatial relations of the palate and pharynx so that intact musculature can achieve closure. No single opera— tion is a panacea. Therefore, one must match the operative procedure or other course of management to the individual anatomic, pathologic and psychologic situation. Mazaheri (17) and Porterfield (25) have proposed similar approaches to the problem. 'We suggest a method for grouping velopharyngeal incompetent mecha— nisms and guidelines for their management. Grouping of Factors Causing Incompetence The patients are grouped in the following way, according to cause of velopharyngeal incompetence instead of the etiologic condition: active palate with anatomic disproportion, immobile palate, ineffective palate, and inconsistent palate. The size of the palatopharyngeal orifice, range of motion in the palate and pharyngeal wall are the major anatomic factors involved in palatopharyngeal closure (6, 24). Each group includes abnormalities caused by both cleft palate and other noncleft palate conditions (13, 25, 26), including levator paralysis, myopathies, and congenital disproportions of the nasopharynx and palate. I. ACTIVE PALATE WITH ANATOMIC DISPROPORTION. Three variations are shown in Figure