[Clinical analysis of velopharyngeal incompetence in patients with folded pharyngeal flap]

Subjects were 51 patients undergoing folded pharyngeal flap surgery for velopharyngeal incompetence at the Department of Otolaryngology of Kagawa Medical University between August 1985 and July 2001. Causal diseases were cleft palate in 27 (53%), submucous cleft palate in 8 (16%), and congenital velopharyngeal incompetence in 16 (31%). In history, 31% with congenital velopharyngeal incompetence, 25% with submucous cleft palate, and 11% with cleft palate had congenital abnormalities. In addition, 56% with congenital velopharyngeal incompetence, 38% with submucous cleft palate, and 15% with cleft palate had mental retardation, indicating that it occurred with high frequency in patients with congenital velopharyngeal incompetence. The postoperative improvement of nasality was investigated in 48 patients whose progress could be observed for more than 1 year. Of 39 preoperatively diagnosed with advanced velopharyngeal dysfunction, 34 (87%) showed improved nasality. Of 9 with preoperatively slight deficiency, 8 (89%) improved nasality. The blowing test showed no difference in results between patients who had advanced and slight deficiency. Articulation on speech level improved to be normal in 78% of patients with slight deficiency, but only in 46% of those with advanced deficiency. Improvement of articulation on a speech level was high (86%) in patients with submucous cleft palate, but low in patients with congenital velopharyngeal incompetence who had mental retardation. Further study is required to detail postoperative prognosis factors.