Objective: The purpose of this investigation was to study lateral pharyngea
l wall adduction relative to pharyngeal flaps of different widths. The hypo
thesis to be tested was that pharyngeal wall adduction does not increase po
stoperatively but may decrease due to the mechanical hindrance of a wide fl
ap.
Design: In this prospective study, adaptation of lateral pharyngeal wall ad
duction during speech was studied relative to pharyngeal flaps of different
widths utilizing videoradiography, Flap width was determined nasopharyngos
copically,
Setting: All patients were treated by the Stockholm Cleft Palate Team, Swed
en,
Patients: Fifty-three patients were strictly selected by discarding conditi
ons known to exert uncontrolled influence on velopharyngeal sphincter funct
ion.
Results: The results revealed a potential for adaptation of pharyngeal wall
adduction to different flap widths, The magnitude and character (increase
or decrease) of change in adduction was significantly correlated with the d
egree of preoperative adduction and with the width of the flap. In patients
with limited preoperative adduction, pharyngeal wall activity increased, m
ore in the presence of a narrow flap while less if the flap was wide. When
preoperative adduction was pronounced, the postoperative activity decreased
because of mechanical hindrance by the flap, and the degree of impediment
was correlated to the width of the flap.
Conclusion: A potential for increased lateral pharyngeal wall adduction aft
er pharyngeal flap surgery was verified, but the result cannot be interpret
ed as generally applicable because of the strict selection of patients.