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Introduction: Superiorly based pharyngeal flap is one of the most common surgical techniques described for surgical correction of velopharyngeal disorders. Being a technique-sensitive and owing to its associated complications, a simple technique has been introduced and compared with it. Aim: The aim was to compare the surgical results and the phoniatric outcome of the superiorly based pharyngeal flap versus the myomucosal resection and direct closure of the posterior pharyngeal wall. Patients and Method: One hundred patients of both sexes were classified into two groups. Group A patients included fifty patients who had velopharyngeal insufficiency (VPI) and were surgically corrected by the superiorly based pharyngeal flap. Group B patients included fifty patients who had VPI and were surgically corrected by myomucosal resection and direct closure of the posterior pharyngeal wall. Results: Postoperatively, 13% of Group A patients had open nasality Grade 4 as compared to 0% in Group B patients. Hyponasality and obstructive sleep apnea were not recorded in any case of Group B patients as compared with 10% of Group A patients. With regard to the postoperative velopharyngeal gap during speech, 18% of patients in Group A had velopharyngeal gap 3 mm, while 10% of patients in Group B had velopharyngeal gap 3 mm. Conclusion: Myomucosal resection and direct closure of the posterior pharyngeal wall is a simple reliable technique for the correction of velopharyngeal disorders.

This study aimed to document the prevalence, severity, and risk factors of velopharyngeal dysfunction (VPD) in craniofacial microsomia (CFM) and to analyse differences in VPD-related speech characteristics between CFM patients without cleft lip and/or palate (CL/P), CFM patients with CL/P, and CL/P patients without CFM (control). A total of 223 patients with CFM were included, of whom 59 had a CL/P. Thirty-four CFM patients had VPD, including 20 with a CL/P. VPD was significantly more prevalent in CFM with CL/P than in CFM without CL/P (odds ratio (OR) 4.1, 95% confidence interval (CI) 1.9–8.7; P < 0.001). Multivariate logistic regression showed a significant association between CL/P and VPD in CFM patients (OR 7.4, 95% CI 2.1–26.3; P = 0.002). The presence of VPD was not associated with sex, the laterality or severity of CFM. Speech problems related to VPD appeared to be similar among the different groups (CFM without CL/P, CFM with CL/P, CL/P without CFM). As 15.2% of all CFM patients and 8.5% of CFM patients without CL/P had VPD, it is proposed that all patients with CFM, with or without CL/P, should be assessed by a speech and language therapist for the potential risk of VPD. [ABSTRACT FROM AUTHOR]

To longitudinally investigate speech production (consonant proficiency, consonant errors and perceived velopharyngeal competence) in 17 internationally adopted (IA) children with unilateral cleft lip and palate (UCLP) at three time points. Consonant proficiency (percent consonants correct, consonant inventory) and number and type of consonant errors were calculated based on blind phonetic transcriptions of words from the Swedish Test of Articulation and Nasality (SVANTE). Velopharyngeal competence was perceptually rated by three blinded experienced speech-language pathologists at the ages of 3, 5 and 7–8 years. A significant positive development of speech production was found, although most children still scored very low for consonant proficiency at the age of 7–8 compared with normative values: the median for percent consonants correct was 79.7 and many children still had persisting cleft-related and developmental consonant errors. At the age of 7–8, almost half of the children were rated as having a competent velopharyngeal function and only three as having an incompetent velopharyngeal function. Persisting speech difficulties at school age in IA children with UCLP were found in the present study, which is one of the very few longitudinal studies. Our results highlight the need for detailed follow-up of speech production in clinical settings. Speech disorders may have a severe impact on a child's intelligibility and participation with peers, and there is a need for more studies investigating the actual everyday effect of the difficulties found. [ABSTRACT FROM AUTHOR]

The velopalatine sphincter is a muscular valve that creates a hermetic seal between the nasopharynx and the oropharynx. It guarantees phonation, swallowing, and breathing (forces expirations). In wind musicians, sphincter closure must be precise during sound generation. Its failure will cause velopharyngeal incompetence (VPI) and the end of professional success. The objective of this article was to conduct a state-of-art review of VPI in wind musicians with a systematic approach based on the PRISMA Statement. The etiology, epidemiology, clinic, diagnosis, and treatment of VPI in wind musicians were evaluated. The research was carried out in different databases (PubMed/MEDLINE, the Cochrane Library, Scielo) and through the Mergullador metasearch engine. A total of 20 publications were selected. VPI is a pathology that affects around one-third of wind musicians according to studies. It causes pharyngeal noises and nasal air emissions during performance. The main etiology seems to be the fatigue of the velopalatine sphincter muscles. The most used diagnostic techniques consist of clinical history, physical examination, and nasofibroscopy. There is no consensus among authors about therapeutic management. Future investigations are necessary to confirm that fatigue of velopalatine sphincter muscles and other factors that increase it are the main causes of VPI in wind musicians. [ABSTRACT FROM AUTHOR]

Isolated unilateral palatal hypoplasia is an extremely rare congenital disorder that usually causes velopharyngeal incompetence. We herein report a case with isolated unilateral palatal hypoplasia that was treated and followed up over nine years. No hypernasality or articulation errors were observed through the postoperative period. Here the intraoperative and postoperative findings are described. [ABSTRACT FROM AUTHOR]

Summary/introduction: Velopharyngeal incompetence(VPI) is the failure of closure of the velopharyngeal sphincter, which consists of the muscles of the soft palate and the superior pharyngeal constrictor, and functions to separate the nasopharynx and oropharynx during phonation and swallowing. VPI is most frequently congenital/syndromic (with structural deficit) but can be acquired. A subset of acquired VPI, occurring in structurally intact velopharynx, has been described in children, and these are isolated and acute-onset, with a substantial proportion thought to have an infectious origin. So far measles was identified to be the aetiology in one reported case. This report aims to create awareness that VPI could be a rare post-measles complication., Case Report: A two-year-old female who, two weeks after a measles episode, developed sudden-onset nasal regurgitation, rhinolalia, and dysphagia. She had never experienced these symptoms before and has not had any recent throat surgeries. The review of systems was not contributory. On examination, she was ill-looking with no dysmorphic features; was not febrile or pale, and had generalized brownish-scaly, desquamating skin lesions. Nasal regurgitation of liquids was observed when she drank. Oral/oropharyngeal examination revealed no structural defects but she had absent gag reflex with bilateral palatal paralysis (indicating Glossopharyngeal and Vagus nerve palsies). All other neurological and systemic findings were normal. Management was conservative with a Nasogastric tube for feeding. She made a complete recovery with total restoration of neurologic functions after 21 days. Six-month follow-up revealed no recurrence or signs of progression., Conclusion: This report adds to the evidence that measles is one of the infectious causes of acute-onset isolated VPI. The proposed mechanisms underlying this unusual manifestation of measles are direct viral neuronal injury given its neurotropic nature; and autoimmune neuronal injury. The reason for the rarity of this post-measles complication despite the high incidence of measles remains to be elucidated., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Objective: To determine the efficacy and resource utilization of through-and-through dissection of the soft palate for pharyngeal flap inset for velopharyngeal incompetence (VPI) of any indication. Design: Retrospective review. Setting: Tertiary care center. Patients: Thirty patients were included. Inclusion criteria were diagnosis of severe VPI based on perceptual speech assessment, confirmed by nasoendoscopy or videofluoroscopy; VPI managed surgically with modified pharyngeal flap with through-and-through dissection of the soft palate; and minimum 6 months follow-up. Patients with 22q11.2 deletion syndrome were excluded. Intervention: Modified pharyngeal flap with through-and-through dissection of the soft palate. Main Outcome Measure(s): Velopharyngeal competence and speech assessed using the Speech-Language Pathologist 3 scale. Results: The median preoperative speech score was 11 of 13 (range, 7 to 13), which improved significantly to a median postoperative score of 1 of 13 (range 0-7; P <.001). Velopharyngeal competence was restored in 25 (83%) patients, borderline competence in 3 (10%), and VPI persisted in 2 (7%) patients. Complications included 1 palatal fistula that required elective revision and 1 mild obstructive sleep apnea that did not require flap takedown. Median skin-to-skin operative time was 73.5 minutes, and median length of stay (LOS) was 50.3 hours. Conclusions: This technique allows direct visualization of flap placement and largely restores velopharyngeal competence irrespective of VPI etiology, with low complication rates. Short operative time and LOS extend the value proposition, making this technique not only efficacious but also a resource-efficient option for surgical management of severe VPI. [ABSTRACT FROM AUTHOR]

Presence of metastatic tumour in the retropharyngeal node has a negative impact on the prognosis. We present here our 5-year experience and the outcomes of transoral robotic retropharyngeal node dissection (RPND) in salvage settings. Hospital database was accessed to extract details of patients with head and neck cancer who developed retropharyngeal (RP) node metastasis. Patients who underwent transoral robotic surgery (TORS) for RPND in salvage settings were included for the study. Patients were first followed-up after 10 days of discharge and then on a monthly basis after completion of treatment. At each follow-up, swallow functions and disease status were recorded. A total of 10 patients met the inclusion criteria and underwent salvage transoral robotic RPND. The total number of lymph nodes removed from these patients were 11, with all having malignant tumour deposits. The median follow-up was 20 months. Four patients developed distant metastasis. There were no major procedure-related complications. Our experience suggests that TORS as treatment modality is oncologically sound and feasible for salvage RP node dissection. Level of evidence Retrospective Study (3). [ABSTRACT FROM AUTHOR]

Velopharyngeal dysfunction is a palatal defect that occurs when the soft palate or the velum fails to close an opening called the velopharyngeal port or lift adequately to posterior pharyngeal wall. It primarily affects the articulation and resonance of speech and often leads to nasal intonation due to escape of air through the nose. This article presents a series of such cases that have been treated by prosthodontic rehabilitation. [ABSTRACT FROM AUTHOR]

Objectives: (1) To determine the incidence rate of velopharyngeal dysfunction (VPD) according to 7 speech criteria post-Furlow palatoplasty. (2) To find an anatomical measurement of the cleft palate (or combination of measurements) associated with the occurrence of VPD. Study design: Retrospective cohort study. Participants and Methods: Fifty-six patients with cleft palate ± cleft lip underwent palatoplasty with the Furlow technique at the age of 10 months. Pre-and post-palatoplasty cleft palate measurements were collected during the procedure. Three blinded speech-language pathologists (SLPs) retrospectively scored the patients from the chart data at age 4. Student t test and receiver operating characteristic curve analysis were used to evaluate the association and predictive capacity between cleft measurements and parameters (M&P) with all VPD criteria. Results: The SLPs found an incidence of VPD according to 7 criteria: hypernasality (11%), audible nasal emission (4%), nasal rustle (14%), compensatory errors (4%), impairment of speech understandability (7%), and impairment of speech acceptability (16%). The SLPs recommended a secondary surgical procedure in 5 patients (9%). A statistically significant association was found between, respectively, 17 and 5 M&P and the occurrence of compensatory errors and audible nasal emission. Our data suggest that the length of the cleft, the cleft area, and the postoperative transversal size of the nasopharynx are the best indicators of the future positivity of VPD criteria. Conclusion: The size of the postoperative transverse nasopharyngeal area during the primary cleft palate procedure may become the focus of the next generation of cleft surgeons to reduce the incidence of VPD. [ABSTRACT FROM AUTHOR]

Repair of cleft palate in the adult population is controversial. We present a case of a 66-year-old woman who underwent secondary cleft palate repair. The patient was born with a cleft palate and at age 15 years underwent palate repair that subsequently broke down. She had profound velopharyngeal incompetence, was difficult to understand in conversation, and had a long history of hearing issues requiring hearing aids. She underwent revision palatoplasty and insertion of bilateral grommets. Postoperatively she had marked improvement in her speech, hearing, and quality of life. This case demonstrates the utility of secondary repair of cleft palate in the adult population. [ABSTRACT FROM AUTHOR]

Abstract Background This systematic review aims to inform the development of a screening tool which pre-operatively predicts which children are likely to develop velopharyngeal insufficiency, one of the causes of poor speech outcomes, following cleft palate repair. This would be highly beneficial as it would inform pre-operative counselling of parents, allow targeted speech and language therapy, and enable meaningful comparison of outcomes between surgeons, techniques, and institutions. Currently, it is unclear which factors influence speech outcomes. A systematic review investigating the non-interventional factors which potentially influence speech outcomes following cleft palate repair is warranted. This may be illuminating in itself or provide foundations for future studies. Methods A systematic review will be carried out according to Cochrane methodology and reported according to PRISMA guidelines (PLoS Med 6: e1000097, 2009). Systematic review software will be used to facilitate three-stage screening by two independent reviewers experienced in cleft lip and palate. Thereafter, data extraction and GRADE assessment will be performed in duplicate by five independent reviewers experienced in cleft lip and palate. Studies reporting the proportion of patients who were recommended or underwent secondary speech surgery for velopharyngeal insufficiency following primary surgery for cleft palate will be included. The study findings will be tabulated and summarised. The primary outcome measure will be further speech surgery (either recommended or performed). The secondary outcome measure will be perceptual speech assessment for the presence of velopharyngeal insufficiency. A meta-analysis is planned. However, if this is not possible, due to the anticipated marked heterogeneity of study characteristics, pre-operative assessment, and the recorded outcome measures, a narrative synthesis will be undertaken. Discussion This systematic review may provide sufficient data to inform the development of a screening tool to predict the risk of velopharyngeal insufficiency prior to cleft palate repair. However, it is anticipated that these findings will provide the foundation for future studies in this area. Systematic review registration Registered on 19 December 2016 with PROSPERO CRD42017051624

Objective This study was aimed for nasendoscopic assessment of velopharyngeal sphinteric closure in patients with operated cleft palate and to compare it with normal population. Design A cross-sectional study was done in a tertiary cleft care center in 30 patients with operated cleft palate after a minimum of 6 months of their surgery and 30 randomly selected volunteers with normal speech. Both groups were one-time evaluated by three observers using 70 degree rigid nasendoscope and/or pediatric fiber optic endoscope. Velopharyngeal sphincter closure characteristics in terms of pattern of closure, dominant element involved in the closure, degree of palatal movement, and completeness of the closure were evaluated, recorded, and compared between the groups. Results In both groups, the most common pattern of closure is coronal and soft palate is the dominant mobile element in velopharyngeal closure. All normal subjects showed complete closure of the sphincter with good soft palate movement. But only 50% of the operated patients with cleft showed complete closure and even less than them had good movements of the soft palate. Conclusions Although the pattern of the closure in the operated patients is similar to the normal subjects, the movement of the soft palate and completeness of the velopharyngeal sphincter closure still remain the problem in the operated palate patients.

Objective: To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI). Methods: This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation. Results: Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported. Conclusion: The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication. [ABSTRACT FROM AUTHOR]

Objective: To investigate the therapeutic effects of mechanical inspiration and expiration exercise using mechanical cough assist on velopharyngeal incompetence in patients with subacute stroke. Design: Pilot, randomized controlled study. Setting: University-based rehabilitation centre. Subjects: Thirty-six patients with subacute stroke diagnosed with velopharyngeal incompetence by videofluoroscopic swallowing study. Methods: Subjects were randomly assigned to 2 groups. The study group received conventional dysphagia therapy and additional mechanical inspiration and expiration exercise. The control group received conventional dysphagia therapy only. Swallowing function was evaluated according to the American Speech-Language-Hearing association scale, functional dysphagia score, and the penetration aspiration scale, based on the videofluoroscopic swallowing study. Coughing function was measured using peak cough flow. Results: Eighteen patients in each group completed the protocol and were analysed. After treatment, the study group showed significant improvement in functional dysphagia score with regard to nasal penetration degree. Comparing the treatment effect between the 2 groups, nasal penetration degree and peak cough flow showed greater improvement in the study group. Conclusion: Mechanical inspiration and expiration exercise had a therapeutic effect on velopharyngeal incompetence in subacute stroke patients with dysphagia. This therapy is easy to provide clinically and could be a useful therapeutic strategy for velo-pharyngeal incompetence with dysphagia in patients with stroke.

Velopharyngeal incompetence often distorts the voice quality making it difficult for the listener to comprehend. A cost-effective treatment approach for this is palatal lift prosthesis. This prosthesis enables the incompetent soft palate to approximate with the posterior pharyngeal wall. As a result articulation of speech is improved. [ABSTRACT FROM AUTHOR]

Objectives: To assess the outcome of a modified buccinator flaps' palatal lengthening combined with radical intravelar veloplasty (Bs + Re: IVVP) for the management of postpalatoplasty velopharyngeal incompetence and report the functional and structural changes occurring in the palate. Design: Prospective cohort study of consecutive cleft patients presenting with velopharyngeal incompetence and managed by buccinator re-repair procedure. Blind assessment of randomized recordings of speech and evaluation of velar form and function with nasoendoscopy and lateral videofluoroscopy were done. Patients' demographic data were also collected. Patients: Among 30 consecutive cases who had Bs + Re: IVVP, 24 had adequate pre- and postoperative records of speech outcome data. Setting: Multidisciplinary cleft team in a tertiary referral center. Results: There were significant improvements in hypernasality, nasal emission, facial grimace and weak consonants, and overall intelligibility of speech. Endoscopy and lateral videofluoroscopy showed significant improvement in total and functional velar length, closure ratio, velopharyngeal gap at closure, palatal thickness, palatal convexity, and mobility. Regarding the procedure complications, no flap ischemia, fistula, or obstructive sleep apnea reported, but there were one cheek hematoma and two minor oral mucosal dehiscence which healed spontaneously. Conclusions: Buccinator re-repair (Bs + Re: IVVP) has been shown to be an effective and safe procedure in treating difficult postpalatoplasty velopharyngeal incompetence. It was also shown that it is still a physiological nonobstructive procedure with low morbidity. [ABSTRACT FROM AUTHOR]

We present a family with a previously undescribed abnormality of the palate and oropharynx which involved the absence of the uvula and the anterior pillar of the fauces, rudimentary posterior pillar of the fauces, and hypernasality. Eight family members over 4 generations are affected in a pattern consistent with autosomal dominant inheritance. A causal role for the FOXF2 gene has been identified and previously reported. We describe the management of the proband, which involved attempting to lengthen the palate and to retroposition the abnormally anteriorly directed velar musculature, along with speech therapy. [ABSTRACT FROM AUTHOR]

Idiopathic hemipalatal hypoplasia is rare and leads to speech problems and the regurgitation of fluids, and the reconstruction of asymmetrical velopharyngeal incompetence is a challenge to the cleft surgeon. We present a case in a 5-year-old boy, and introduce the one-stage surgical technique that we used to resolve it. [ABSTRACT FROM AUTHOR]

This article reports the evaluation of the therapeutic effect of a palatal lift prosthesis with a specially designed connection between the anterior denture base and the palatal lifting plate in a patient with velopharyngeal incompetence due to severe brain injury. [ABSTRACT FROM AUTHOR]

Objectives: Velopharyngeal dysfunction (VPD) secondary to neuromuscular pathology is well recognized. Surgical treatment in these patients using palatoplasty or conventional sphincteric and posterior flap-based pharyngoplasty is often contraindicated as they may further weaken or aggravate already impaired musculature. We report a small case series of patients who underwent successful long-term treatment for VPD of neurogenic origin using an injectable gel polymer to augment the posterior pharyngeal wall. Design: Three patients in whom a neuromuscular condition had led to the development of VPD underwent augmentation pharyngoplasty. Speech was compared pre- and post-operatively examining hypernasality, nasal emission, and nasalance scores and patient self-evaluation of outcome. Results: All three patients had improvement in parameters measured following pharyngeal injection augmentation. One patient noticed deterioration in speech intelligibility following initial injection into the velum: the implant polymer was easily removed and later reinjected in the posterior pharynx with good effect. Conclusions: The use of gel polymer injection pharyngoplasty in the treatment of neurogenic VPD was safe, simple, well tolerated, and easily reversible. However, due to recent severe complications reported from fat augmentation pharyngoplasty, we would not recommend its routine usage.

Objective This study was aimed for nasendoscopic assessment of velopharyngeal sphinteric closure in patients with operated cleft palate and to compare it with normal population. Design A cross-sectional study was done in a tertiary cleft care center in 30 patients with operated cleft palate after a minimum of 6 months of their surgery and 30 randomly selected volunteers with normal speech. Both groups were one-time evaluated by three observers using 70 degree rigid nasendoscope and/or pediatric fiber optic endoscope. Velopharyngeal sphincter closure characteristics in terms of pattern of closure, dominant element involved in the closure, degree of palatal movement, and completeness of the closure were evaluated, recorded, and compared between the groups. Results In both groups, the most common pattern of closure is coronal and soft palate is the dominant mobile element in velopharyngeal closure. All normal subjects showed complete closure of the sphincter with good soft palate movement. But only 50% of the operated patients with cleft showed complete closure and even less than them had good movements of the soft palate. Conclusions Although the pattern of the closure in the operated patients is similar to the normal subjects, the movement of the soft palate and completeness of the velopharyngeal sphincter closure still remain the problem in the operated palate patients. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: The soft palate plays a vital role in velopharyngeal closure which is strongly dependent on a close coordination of the velum and the contiguous pharyngeal structures. It is reasonable to hypothesize that these structures may have different characteristics to match up to different soft palate morphologies. Considering this, the present study was done to investigate the variation in the morphology of the soft palate. Materials and Methods: A total of 200 patients belonging to both the genders, in the age group 5-55 years, were selected from the outpatients visiting the Department of Oral Medicine and Radiology. All the study samples were subjected to lateral cephalogram and the morphology of the soft palate was categorized as described by You et al. Any additional finding was further differentiated as type 7 and so on. The length of soft palate was also evaluated using Sidexis next generation software. The data obtained were tabulated and subjected to statistical analysis. Results: The morphology of soft palate was categorized into eight types. Type 1 was the commonest type observed. The relationship between the different types of soft palate in various age groups was found to be non-significant. The mean length of the soft palate was found to be more in group V (46-55 years). The mean length of soft palate was found to be higher in males. There was a positive correlation between age and type of soft palate. Conclusion: The present study draws a new set of morphological classification for the soft palate.

Background: The purpose of this review was to assess the effectiveness of the buccal myomucosal flap in secondary repairs of cleft palate in 20 patients. Patients and Methods: Totally, 20 patients, who underwent secondary palatoplasty between 5 years and 8 years in which a buccal myomucosal flap was used, were reviewed retrospectively. All patients had undergone at least one previous attempted repair at other institutions. Indications for the secondary repair included velopharyngeal incompetence and/or oronasal fistula. Patients were evaluated preoperatively for oronasal fistula status, velopharyngeal competence, nasal resonance, speech quality, and nasal escape. Results: The buccal myomucosal flap was used in all 20 patients, and there was marked increase in the quality of speech as well as nasal regurgitation decreased. In patients with levator dysfunction due to poor primary surgery and glottal speech the results were inconclusive Conclusion: Palate re-repair combined with a buccal myomucosal flap, occasionally in conjunction with other techniques, is an effective method for correcting failed cleft palate repairs. Minimum donor site morbidity and complication makes the buccal flap a useful armamentarium of a cleft surgeon.

Summary Objectives Palatal re-repair aims to improve velar function by retro-positioning the levator veli palatini muscles. The surgery includes extensive dissection, leading to tissue edema and scar formation which may need time to remodel. Together with the change of muscle orientation and tension, it is expected that a period of time is needed to reach the final functional performance. This study attempts to determine how much time is required to reach the optimum performance of the palate after re-repair. Methods A retrospective chart review identified consecutive cleft patients with VPI who underwent palate re-repair procedure by a single surgeon from 2000 to 2015 and achieved normal or borderline normal VP function. Only patients who had regular postoperative follow-up visits for speech assessments until resolution of speech abnormalities were included. The percent of patients cured at each time point following surgery was recorded. Results Forty-five patients met the inclusion criteria. The mean age at surgery was 6.6 ± 3.2 years. Speech abnormalities had resolved in 44.5% of patients within the first 6 months after surgery, 62.2% after up to 1 year, 75.6% after up to 2 years and 88.9% after up to 3 years post re-repair palatoplasty. The remaining 11.1% continued to improve after 3 years up to 6 years. Conclusions Re-repair procedures may take a longer time than previously thought for the final outcome to manifest. Close monitoring of improvement with continued speech therapy is recommended before deciding to move to the next surgical step in management. [ABSTRACT FROM AUTHOR]

Objective: The present study investigates the efficacy of performing a “palate rerepair” utilizing a double-opposing z-palatoplasty (DOZ) following primary Furlow palatoplasty. Design: Retrospective study. Setting: Tertiary referral academic center for craniofacial surgery. Patients: 15 consecutive patients who presented with velopharyngeal insufficiency (VPI) after primary Furlow palatoplasty. Main Outcome Measures: All subjects were evaluated using the perceptual speech assessment (PSA) scale. Criteria for inclusion in the study were (1) velopharyngeal gap size on phonation of 7 mm or less and (2) lateral wall motion at least 40% normal. Results: Mean PSA score was 7.13 + 3.31 (range 3-13) preoperatively, and decreased to 1.80 + 2.83 (range 0-11; P < .001 vs baseline) 3 months or more after surgery. A sphincter pharyngoplasty was performed as a tertiary procedure in 2 patients due to persistent nasal air emission. There was no symptomatic airway compromise following secondary or tertiary management in all patients. Presence of a cleft lip, lateral wall motion, and velopharyngeal gap size did not impact outcomes. Conclusions: We have demonstrated that a DOZ performed secondarily is anatomically possible following Furlow palatoplasty and can restore function of the levator muscle despite significant scarring following primary repair. This approach respects anatomic principles of palatoplasty without eliminating the possibility for extrapalatal procedures should velopharyngeal competence not be achieved. [ABSTRACT FROM AUTHOR]

Aim To describe a comprehensive management protocol to treat cleft maxillary hypoplasia specific to the patient's age, degree of hypoplasia and presence or absence of velopharyngeal incompetence (VPI). Materials and methods A total of 359 patients suffering from cleft maxillary hypoplasia were retrospectively studied from January 2004 till June 2015. Lateral cephalograms were taken to assess the degree of deformity and advancement achieved at three intervals. Patients were treated by four treatment modalities: Facemask therapy, Anterior maxillary advancement, Total maxillary osteogenesis and LeFort I advancement. Results 359 patients of cleft maxillary hypoplasia were treated and followed up for a mean of 25 ± 3.6 months. Group I had 20 patients, all in the pre-pubertal age group with less than 11 mm discrepancy. 25% of patients in this group had relapse; Group II: 196 patients who were all above 11 years of age and included all grades of hypoplasia, only 6.25% patients had relapse; Group III had 36 patients all with severe form of hypoplasia and were above 5 years of age. Relapse in this group was 16.6%; Group IV had 102 patients who were above 16 years of age and had mildmoderate severity of hypoplasia. Relapse rate was 18.75%. Conclusion Extensive literature search and our institutional study has helped us formulate a protocol that delineates the most appropriate treatment modality for a specific age group and degree of hypoplasia also considering the effect of treatment on velopharyngeal incompetence. [ABSTRACT FROM AUTHOR]

Objective: To present various ways of transfer and result of buccinator myomucosal flap (BMMF) in primary and secondary repair of palatal cleft and palate fistula. Design: This study has been designed on the basis of a clinical experience and literature search. Route of single or two BMMF(s) transfer was either lateral or posterior to the greater palatine neurovascular bundle. The flap has been used to repair defect in nasal layer, oral layer, or in combined nasal as well as oral layer of the palate. Materials and Methods: More than 160 palatoplasties have undergone palate repair with the use of BMMFs between 1999 and 2011. The analysis includes 98 palate repair. Unilateral flap was used most commonly in primary repair of nasal side of wide unilateral cleft palate (CP); whereas, two flaps were used mostly in primary repair of wide bilateral CP and in secondary palate repair for large fistula. Results: The fistula rate; in primary palatoplasty patients was 4.8% and in secondary palatoplasty patients, it was 8.3%. Good speech has been achieved in primary palatoplasty patients. After secondary palatoplasty also patients had good speech following therapy. Conclusion: The presented technique has been effective in anatomical and functional repair of wide palatal defects primary as well as secondary. The literature has been reviewed along with.

Background: Cleft lip and palate repair seeks to restore normal form, improve feeding and achieve normal speech, which requires velopharyngeal competence. The absence of this ability, termed velopharyngeal insufficiency (VPI), is seen in a wide range of patients following primary cleft palate repair. This review article focuses on patient assessment and the surgical management of VPI. Recent trends and future directions in management are also presented. After reading, one should be able to describe the various treatment approaches for a patient with suspected VPI. Materials and Methods: A PubMed search was conducted using the following search terms: VPI, velopharygneal incompetence, VPI, velopharynx, velopharyngeal port, velopharyngeal mechanism, veloplasty, intravelar veloplasty and hypernasal speech. Relevant manuscripts were identified by abstract review and additional articles selected based on bibliography review. Articles were restricted to those in the English language. A total of 88 articles were selected for further review. Conclusions: VPI is a common complication following primary palatoplasty. The decision to operate, as well as the selection of operative procedure, depends on a multimodal patient assessment, including speech evaluation and imaging studies of the pharyngeal mechanism. A thorough understanding of velopharyngeal anatomy and physiology is crucial to understanding the deficits in patients with VPI as well as the myriad methods of surgical correction. While many techniques are available, there are no conclusive data to guide procedure choice and newer techniques of imaging and treating patients with VPI continue to evolve.

Background and Objective: Although cleft palate is the most common cause of velopharyngeal dysfunction (VPD), other disorders can also cause hypernasality and/or nasal emission. Velopharyngeal incompetence (VPI) is one of the VPD. VPI is usually associated with a cleft palate but it can occur without a cleft palate. Congenital myopathy (CM) is a muscular disorder that recognizes early onset of the disease, muscle weakness, hypotonia and delayed motor development. Yet do not specify the effect of VPI due to CM, on speech. The purpose of this paper was to describe a case of VPI as one of the main clinical manifestations in a patient with a congenital myopathy. Case presentation: The patient was a four years old female. There was no family history of cleft palate or lip. The only complaint of the family was unclear speech and her hypernasality. After perceptual assessment and diagnosis of severe hypernasality, endoscopy was performed. Endoscopy showed that in the absence of structural abnormalities, soft palate and pharynx walls were moveless. there was a medium gap too. Discussion: Patient speech errors in high-pressure consonants, were severe hypernasality, posterior-nasal fricative and nasal emission. These errors are special features of cleft palate, but in device evaluation, she had no obvious or even submucosal cleft palate. With reference to the neurologist, specify the VPI symptoms, resulting from congenital myopathy. The report emphasizes the need to suspect to a neuromuscular disease when a VPI is diagnosed and there is no evidence of an upper abdominal ulcer and abdominal endoscopic cleft. [ABSTRACT FROM AUTHOR]

Context: Videofluoroscopy in operated cleft palate patients. Aims: To determine the existence of an optimal resting velopharyngeal (VP) gap in operated cleft palate patients Settings and Design: A retrospective analysis of lateral view videofluoroscopy of operated cleft palate patients. Materials and Methods: A total of 117 cases of operated cleft palate underwent videofluoroscopy between 2006 and 2011. The lateral view of videofluoroscopy was utilised in the study. A retrospective analysis of the lateral view of videofluoroscopy of these 117 patients was performed to analyse the resting VP gap and its relationship to VP closure. Statistical analysis used: None. Results: Of the 117 cases, 35 had a resting gap of less than 6 mm, 34 had a resting gap between 6 and 10 mm and 48 patients had a resting gap of more than 10 mm. Conclusions: The conclusive finding was that almost all the patients with a resting gap of 10 mm (group A) did not achieve VP closure on phonation, thus having full-blown VPI. Therefore, it can be concluded that the ideal resting VP gap is approximately 6 mm so as to get the maximal chance of VP closure and thus prevent VPI.

Postadenotonsillectomy velopharyngeal incompetence/insufficiency/dysfunction (VPI) is an uncommon but potentially surgically challenging problem. We report a child without cleft palate who developed severe palatoglossal arch cicatrix and VPI after adenotonsillectomy, and describe bilateral palatoglossal arch z-plasty to restore palatal function and speech. [ABSTRACT FROM AUTHOR]

The presence of nasal air leak in cleft palate patients with velopharyngeal incompetence leads to characteristic nasal snort. The efficacy of the palatal lift appliance in patients with adequate velopharyngeal tissue with incompetence was tested. Speech quality improved after the wearing of palatal lift appliance. Palatal lift appliances are simple and efficient in reducing the nasal air leak. Ongoing speech therapy is necessary and advised for patients receiving palatal lift.

Speech is a complex process. The evaluation of speech in an individual with cleft palate is difficult, and the existing classification of phonemes is complicated. Sanskrit, an ancient language, has an arrangement of alphabets that is orderly and scientific and therefore provides a simple means to understand the production of phonemes and memorize them. This article demonstrates the inherent advantage of this arrangement of Sanskrit alphabets to effectively analyze defective cleft palate speech and provides a tool for surgeons to decide a course of action in their routine clinical practice. Improved insight into the speech defect by the surgeon also facilitates better coordination with the speech language pathologist in assessment and treatment of a child with cleft palate.

Objectives/hypothesis: Evaluate the effect of topical application of autologous platelet-rich plasma (PRP) in primary repair of complete cleft palate and then compare the result with another group of patients using the same surgical technique, without application of PRP with regard to the incidence of oronasal fistula, velopharyngeal closure, and grade of nasality.Study Design: Case control study.Methods: This study was carried on 44 children with complete cleft palate with age range from 12 to 23 months. The children were divided into two age- and gender-matched groups: All children were subjected to the same technique of V-Y pushback repair of the complete cleft palate. In group A (22 children), the PRP prepared from the patient was topically applied between the nasal and oral mucosa layer during palatoplasty, whereas in group B (22 children) the PRP was not applied.Results: All cases were recovered smoothly without problems. In group A, no oronasal fistula was reported, whereas in group B three patients (13.6%) had postoperative fistulae and two patients (9.1%) needed revision palatoplasty. At 6 months postoperative assessment, group A (with PRP application) showed significantly better grade of nasality (P = 0.024) and better endoscopic velopharyngeal closure (P = 0.016) than group B.Conclusion: Usage of autologous PRP in complete cleft palate repair is simple; effective; can decrease the incidence of oronasal fistula; and also significantly improves the grade of nasality and velopharyngeal closure, which decreases the need of further surgical intervention in cleft palate patients.Level Of Evidence: 3b. Laryngoscope, 126:1524-1528, 2016. [ABSTRACT FROM AUTHOR]

The Hynes pharyngoplasty is the second most often performed procedure for velopharyngeal insufficiency in the United Kingdom and Ireland. A crucial step of the procedure is reliable fixation of the flaps onto the posterior pharynx wall. We prefer to fix the flaps to the prevertebral fascia. By using a manually straightened needle and a skin hook, in our hands, placement of this stitch can be made easier and faster. [ABSTRACT FROM AUTHOR]