TREATMENT OF ASYMMETRIC VELOPHARYNGEAL INSUFFICIENCY WITH SKEWED PHARYNGEAL FLAP

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.