THE SELF-LINED SUPERIORLY BASED PULL-THROUGH VELOPHARYNGOPLASTY - PLASTIC SURGERY-SPEECH PATHOLOGY INTERACTION IN THE MANAGEMENT OF VELOPHARYNGEAL INSUFFICIENCY

We present a rationale and step-by-step description of a previously un published innovative surgical technique designed to overcome velophary ngeal, insufficiency This procedure maintains the anatomic integrity a nd physiologic function of the velopharynx by limiting interpalatal di ssection and incorporates a method for flap attachment through the vel um that is accessible, predictable, and versatile. The efficacy of thi s procedure in eliminating velopharyngeal insufficiency was evaluated by using rigorously controlled quantitative psychophysical scaling pro cedures of presurgical and postsurgical perceptual ratings of resonanc e, nasal emission, and intelligibility and instrumental acoustic analy ses. The results indicated significantly better postsurgical speech ou tcomes by individuals treated with the pull-through velopharyngoplasty than did patients treated with other procedures designed for the seco ndary management of velopharyngeal insufficiency. Based on our experie nce with more than 150 patients, we believe that the self-lined superi orly based pull-through velopharyngoplasty represents an advancement i n the surgical treatment of velopharyngeal insufficiency.