The Treatment of Velopharyngeal Incompetency by Bilateral Island Sandwich Flap Combined with Superiorly Based Pharyngeal Flap

Abstract

Velopharyngeal incompetency is a difficult management problem and despite intensive speech therapy and satisfactory motivation, there re— main patients with intact palates who are unable to speak without hyper-nasality. Most of these patients have had palatal clefts which were repaired without adequate lengthening while the remainder have either primary neuromuscular disease of the velo-pharyngeal (VP) sphincter or congenitally large pharynx (3). Whatever the cause, the size of the VP lumen can be measured. Warren (.9) has correlated VP lumen size with competence and degrees of incompetent VP closure. Hypernasal resonance results when the VP lumen size is greater than 20 sq. mm., and gross nasal escape is often present when the lumen is 20 sq. mm., its severity being directly related to the port size over 20 sq. mm. In each pathologic situation the soft palate does not reach the posterior pharyngeal wall or, more accurately, it does not reduce the cross sectional area of the VP lumen to less than 20 sq. mm. when attempting closure. Historical Many surgical techniques are available to accomplish narrowing of the VP lumen. Some of these involve the addition of tissue to the soft palate