Correction of Poor Speech Due To A Low Pharyngeal Flap Attachment By A V-Y Advancement Procedure

Abstract

Four post cleft palate patients with persistent hypernasality resulting from low superiorly based pharyngeal flap attachments were operated on using a V—Y Advancement procedure. In each patient, the tethering effect of the flap on the soft palate was overcome. Gratzfying correction of hypernasality was achieved and articulation ability considerably improved. Long—term follow-up results are not yet available as our experience with this procedure extends over a period of only two years in all. There appear to be two main causes of hypernasality following pha-ryngeal flap surgery for velo-pharyngeal incompetence. These are a persistence of the velo-pharyngeal incompetence because the sphincter is inadequate cross-sectionally or because of low attachment of the pharyngeal flap. A combination of both of these factors could also be present. '-In the former situation, the cross-sectional diameter of the velo-pharyngeal sphincter remains excessive in relation to the ability of the surrounding musculature to achieve closure. The use of local tissue flaps superimposed on the existing pharyngeal flap with the object of further reducing the cross-sectional diameter of the incompetent V—P sphincter offers hope for further improvement in speech (Hogan, 1973; Cosman and Falk, 1975; Hirshowitz, and Bar-David, 1976). These techniques are indicated when the pharyngeal flap attachment is at a sufficiently high level and when the elevator action is not counteracted by posterior and downward pull on the soft palate. Should the contrary apply, normal palatal elevation may actually be restricted (Owsley et al., 1972). It would appear that superiorly based pharyngeal flaps are more commonly used than are inferiorly based ones (Williams and W001-house, 1962; Skoog, 1965; Yules, 1971). These flaps may be displaced caudally, perhaps because of scarring of the donor site and inferior traction on the base of the flap. Cosman and Falk_(1975) consider that " differential growth between a scarred flap and the surrounding naso-Both authors are affiliated with