VELOPHARYNGEAL CLOSURE IN TEENAGERS AFTER SURGICAL-TREATMENT OF CLEFT-PALATE AND CHEILOGNATHOURANOSCHISIS

We examined two groups of teenagers (between 13 and 21 years of age) w ho had been surgically treated as small children for congenital cheilo gnathouranoschisis or cleft palate. A group of 62 teenagers had been t reated by the Dept. of Orthodontics at the University of Erlangen-Nure mberg, the other group of 61 by the Dept. of Orthodontics at the Unive rsity of Rostock. There were differences between the two departments i n sequence and time of the surgical closure as well as in the frequenc e of velopharyngoplasties. The velopharyngeal closure was examined in all patients by means of a flexible fibre endoscope which was pushed f orward endonasally up to the choanae. Simultaneously we judged the aud ibility of the nasal perflation while pronouncing /k/. A residual gap during articulation of /k/ with clearly audible or alternately clearly and discreetly audible nasal perflation was noted in 8 subjects in Er langen and 14 subjects in Restock. In subjects whose velum moved only anteriol-posteriorily, closure was likely to be less good than in thos e with a circular closing mechanism of velum and lateral and/or poster ior parts of the pharyngeal musculature. In rare cases we found a good velopharyngeal closure in spite of a large gap between the velum and the posterior pharyngeal wall at rest. This was the case when the velu m moved more against the upper than the posterior wall of the nasophar ynx. Velopharynxplasty did not reduce nasal airflow in case of insuffi cient function of the velar muscles. Differences in the mode of veloph aryngeal closure might be due to statistically significant regional di fferences in skull structure. It is remarkable that velopharyngeal clo sure was complete while swallowing for all tested subjects even if clo sure was incomplete during spontaneous speech.