Longitudinal Evaluation of Articulation and Velopharyngeal Competence of Patients with Pharyngeal Flaps

Abstract

In this study, 129 patients with cleft palate who had pharyngeal flaps were evaluated longitudinally. Articulation scores improved approximately 15 percent following surgery, and by age 16 the majority of subjects achieved velopharyngeal competence and 90 percent correct articulation. The findings also demonstrated that the risk of requiring secondary management increased with the severity of the cleft. In addition, a higher percentage of patients who had received a primary Von Langenbeck procedure required secondary management than did patients who had the Wardill primary palatoplasty. Age at time of the pharyngeal flap operation did not emerge as a critical factor in speech outcome. It is generally reported that the pharyn-geal flap operation successfully improves articulation and establishes velopharyn-geal competence for approximately 80 percent of patients. At present, however, very little is known about the factors re— lated to the success of the procedure. In an early study, Moll et a1 (1963) found that pharyngeal flap width and the patient's age at time of secondary operation were related to the success of the pharyngeal flap Operation. More recently, Riski (1979) reported that patients who received pharyn-geal flaps prior to 6 years of age demonstrated more rapid improvement in articulation and resonance balance than did children who received a pharyngeal flap after age 6.