The Histology and Electromyography of Primary Pharyngeal Flaps

Abstract

There have been many reports in the literature related to the use of pharyngeal flaps in improving palate-pharyngeal function. Pharyngofixa-tion by means of a pharyngeal flap has had increasing usage, both as a primary and secondary procedure. The Plastic Surgery Clinic in Prague has been performing secondary pharyngeal flaps since World War I and primary flaps since 1924. Speech has been improved with pharyngofixation and our best results have been obtained through the use of superior—based primary flaps. For the past twenty years, we have used superior—based pharyngeal flaps in conjunction with the primary cleft palate repair whether the latter is done in one or two stages. In order to assess the value of this operation, anatomical, histological and electromyographical studies have been carried out on the pharyngeal flaps at varying time intervals. Our study was limited to an evaluation of the primary pharyngeal flap. All operations were performed within the period from three to six years of age. Secondary flaps were eliminated from the study, since we were concerned that pre—existing scars in the palate may have had an unfavorable influence. The Technique of Pharyngofixation The pharyngeal flap was fairly wide in all cases being 15 mm. or more in a child of three years. The full thickness of the muscle was included in the flap. The base of a superior-based flap terminated several millimetres below the upper border of the pharyngeal constrictor in order to preserve blood and nerve supply which is so important to the function of the muscle layer. The donor site of the flap was closed with catgut sutures, and when possible, the muscle and mucous membrane layers were sutured separately. By closing the donor site, there is less risk of secondary hemorrhage and the posterior pharyngeal wall is restored. The superior—based pharyngeal flap is sutured into the raw nasal surface on the anterior half of the velum created through a retropositioning operation on the palate (Figure 1a and 1b). The residual open portions of Miroslav Fara is Associate Professor in the