Several Factors Which May Precipitate the Use of Pharyngeal Flap

Abstract

The most distinct manifestation of cleft palate is the resonance pattern usually referred to as nasality. Various authors (9, 10, 13) have suggested that the speech parameter is the most handicapping aspect of the anomaly and, consequently, the most important consideration in the habilitation process for individuals with cleft palate. It would appear that there is general agreement that pharyngeal flap surgery is an effective choice of technique for the establishment of velo-pharyngeal competency and subsequent improvement of resonant quality in the speech of cleft palate persons. Lewin (8) confirms that approximately 80% of the plastic surgeons surveyed utilize this operative technique. Several factors precipitating the application of the procedure, however, must yet be determined. A number of related attitudes and assumptions may be projected. We tend generally to agree, for example, that primary surgical repair of the cleft does not insure adequate velopharyngeal function for speech; at the same time, many cases are recorded in which normal valving and acceptable speech do follow primary repair and, therefore, the need for secondary surgery such as pharyngeal flap is eliminated. Some investigators (2, 3, 4, 6') have alluded to specific primary procedures which either inevitably neces— sitate secondary procedures or generally are successful in avoiding such operations. Others (5, 11) have suggested that acceptable speech development without secondary surgery may be influenced by the type of anatom— ical cleft of the palate. Traditionally, there has also ensued a controversy as to the appropriate time for primary surgical repair of the cleft. Some (1 , 7) are strong advocates of early palatal repair to attain the best possible speech results, while others (12) conclude that repair performed after four years of age is preferred. To date, little has appeared in the literature to confirm that certain cleft types, specific surgical procedures, or the age of primary repair influence the The authors are affiliated with Sinai