Rv. Argamaso et al., TREATMENT OF ASYMMETRIC VELOPHARYNGEAL INSUFFICIENCY WITH SKEWED PHARYNGEAL FLAP, The Cleft palate-craniofacial journal, 31(4), 1994, pp. 287-294
Twenty-two patients, with hypernasal speech and asymmetric velopharyng
eal insufficiency (VPI) identified preoperatively by multi-view videof
luoroscopy and nasopharyngoscopy, were managed with superiorly based p
haryngeal flaps skewed to the side with reduced lateral pharyngeal wal
l movement. Patient age ranged from 5 to 58 years. The etiology of the
VPI Included cleft palate with or without cleft lip, neurogenic VPI,
velocardiofacial syndrome, tumor resection or iatrogenic causes, submu
cous cleft palate, neurofibromatosis, and hemifacial microsomia. Follo
w-up, at 1 year and thereafter, showed resolution of VPI in all but tw
o patients. An auxiliary flap to augment the primary flap was added on
the side of diminished lateral pharyngeal wall motion which corrected
the residual VPI. Three patients developed hyponasality. One was a ch
ild whose symptoms improved with time and growth. Two were adults, but
the hyponasal resonance was mild and required no further intervention
. The advantage of skewing flaps is that at least one port functions a
dequately for ease in respiration and for drainage of secretions, thus
reducing the risk of nasal obstruction. One open port also allows acc
ess for nasoendotracheal intubation should anesthetic be required for
future operations.