Speech Results from the High Attached Pharyngeal Flap Operation

Abstract

The pharyngeal flap operation is performed by many surgeons to correct velopharyngeal incompetence in patients with cleft palate speech. However, some uncertainty exists regarding the effect of this procedure on palatal function, and there is division of opinion regarding the specific techniques for the operation. This divergence is most often ex.-pressed in consideration of the desirability of superiorly based versus inferiorly based pharyngeal flaps. The purpose of the present investigation was to evaluate the ef— fectiveness of pharyngeal flap techniques from the viewpoint of the speech results. Procedures SURGICAL. Blackfield, Owsley, and co-workers reported their early experience with the pharyngeal flap procedure in 1963 (1). The initial operative technique consisted of attaching a superiorly based pharyn-geal flap to the posterior end of the soft palate on its nasal aspect. This was done in a standard manner without splitting the soft palate. No attempt was made to cover the exposed muscle on the undersurface of the pharyngeal flap nor to repair the donor defect on the pharyngeal wall. This technique may be described as the low attached, superiorly based pharyngeal flap, as illustrated in Figure 1. Observations during the postoperative phase revealed that the flap contracted in all of its original dimensions. In conjunction with the scarring, reattachment occurred between the base of the flap and its donor area on the pharyngeal wall. This resulted in downward traction on the flap and the attached posterior edge of the soft palate. After complete healing, the soft palate was fixed to the posterior pharyngeal