Levatorplasty, a new technique to treat hypernasality: anatomical investigations and preliminary clinical results

Background: Velopharyngoplasty is the most commonly used operative techniqu e for the treatment of velopharyngeal insufficiency, By attaching a posteri or pharyngeal flap to the velum, a nonphysiological situation is created in the upper airway. Purpose: The aim of this investigation was to find a new surgical approach to physiological reconstruction of the velopharyngeal sp hincter, Material: Anatomical investigations were performed in four cadaver s, From this study a new surgical technique was developed and called 'levat orplasty': the musculus longus capitis was taken to create a new muscular l oop leading to (a) an augmentation of the posterior wall, (b) a medial shif t of the lateral pharyngeal wall; and (c) stretching of the velum posterior ly. Thus, the velopharyngeal space was reduced and a physiological closure of the nasal airway space could be obtained. Study design: The levatorplast y was employed in nine cleft palate patients with velopharyngeal insufficie ncy, Pre- and postoperatively the velopharyngeal closure was evaluated by p honetic and radiological examination. Results: The operation was easily per formed without major complications, A concentric constriction with decrease of the velopharyngeal space was achieved and a definitive decrease of nasa lance and hypernasality resulted. Conclusion: Long-term follow-ups have to verify whether these results will be stable, They also have to be compared with functional improvements following velopharyngoplasty or pharyngoplasty , Of special interest will be evaluation of the altered mobility of the lat eral pharyngeal walls, (C) 2001 European Association for Cranio-Maxillofaci al Surgery.