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Postoperative evaluation of the folded pharyngeal flap operation for cleft palate patients with velopharyngeal insufficiency.

Yoshimasu H, Sato Y, Mishimagi T, Negishi A - Ann Maxillofac Surg (2015 Jan-Jun)

Bottom Line: Velopharyngeal function is very important for patients with cleft palate to acquire good speech.The cases included 61 males and 36 females, ranging in age from 7 to 50 years.Approximately 95% of patients showed improved velopharyngeal function.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral Care for Systemic Health Support, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.

ABSTRACT

Background: Velopharyngeal function is very important for patients with cleft palate to acquire good speech. For patients with velopharyngeal insufficiency, prosthetic speech appliances and speech therapy are applied first, and then pharyngeal flap surgery to improve velopharyngeal function is performed in our hospital. The folded pharyngeal flap operation was first reported by Isshiki and Morimoto in 1975. We usually use a modification of the original method.

Purpose: The purpose of this research was to introduce our method of the folded pharyngeal flap operation and report the results.

Materials and methods: The folded pharyngeal flap operation was performed for 110 patients with velopharyngeal insufficiency from 1982 to 2010. Of these, the 97 whose postoperative speech function was evaluated are reported. The cases included 61 males and 36 females, ranging in age from 7 to 50 years. The time from surgery to speech assessment ranged from 5 months to 6 years. In order to evaluate preoperative velopharyngeal function, assessment of speech by a trained speech pathologist, nasopharyngoscopy, and cephalometric radiography with contrast media were performed before surgery, and then the appropriate surgery was selected and performed. Postoperative velopharyngeal function was assessed by a trained speech pathologist.

Results: Of the 97 patients who underwent the folded pharyngeal flap operation, 85 (87.6%) showed velopharyngeal competence, 8 (8.2%) showed marginal velopharyngeal incompetence, and only 2 (2.1%) showed velopharyngeal incompetence; in 2 cases (2.1%), hyponasality was present. Approximately 95% of patients showed improved velopharyngeal function.

Conclusions: The folded pharyngeal flap operation based on appropriate preoperative assessment has been shown to be an effective method for the treatment of cleft palate patients with velopharyngeal insufficiency.

No MeSH data available.


Related in: MedlinePlus

Folded pharyngeal flap operation technique. (a) Incision. (b) The soft palate is split in the midline. (c) The flap is folded. (d) The mucosa on the ridge of the flap is denuded. (e) Incision of the nasal mucosa. (f) Suture between flap and velum. (g) Suture between flap and velum. (h) Postoperative condition
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Figure 1: Folded pharyngeal flap operation technique. (a) Incision. (b) The soft palate is split in the midline. (c) The flap is folded. (d) The mucosa on the ridge of the flap is denuded. (e) Incision of the nasal mucosa. (f) Suture between flap and velum. (g) Suture between flap and velum. (h) Postoperative condition

Mentions: The FPF operation was first reported by Isshiki and Morimoto[1] in 1975. Later, Hiramoto et al. reported its modification,[2] and we also reported its modification for patients with severe velopharyngeal insufficiency.[3] We usually use modifications of the original method. Our operative technique is as follows [Figures 1 and 2]. The incisions are placed on the posterior pharyngeal wall, and the superior-based flap is elevated following splitting of the soft palate in the middle. The flap is folded with the mucosa outside. The mucosa on the ridge of the flap is denuded for attachment of the flap to the soft palate. Incisions are made in the nasal mucosa of the soft palate. In the case of a very short palate or in the case of poor mobility of the soft palate and pharyngeal walls, the incisions are extended toward the flap base [type III in Figure 2]. Sutures are placed between the flap and the soft palate from the lateral side to the medial side. In severe cases, sutures are placed around a 5 mm diameter suction tube. Finally, the soft palate is sutured.


Postoperative evaluation of the folded pharyngeal flap operation for cleft palate patients with velopharyngeal insufficiency.

Yoshimasu H, Sato Y, Mishimagi T, Negishi A - Ann Maxillofac Surg (2015 Jan-Jun)

Folded pharyngeal flap operation technique. (a) Incision. (b) The soft palate is split in the midline. (c) The flap is folded. (d) The mucosa on the ridge of the flap is denuded. (e) Incision of the nasal mucosa. (f) Suture between flap and velum. (g) Suture between flap and velum. (h) Postoperative condition
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555951&req=5

Figure 1: Folded pharyngeal flap operation technique. (a) Incision. (b) The soft palate is split in the midline. (c) The flap is folded. (d) The mucosa on the ridge of the flap is denuded. (e) Incision of the nasal mucosa. (f) Suture between flap and velum. (g) Suture between flap and velum. (h) Postoperative condition
Mentions: The FPF operation was first reported by Isshiki and Morimoto[1] in 1975. Later, Hiramoto et al. reported its modification,[2] and we also reported its modification for patients with severe velopharyngeal insufficiency.[3] We usually use modifications of the original method. Our operative technique is as follows [Figures 1 and 2]. The incisions are placed on the posterior pharyngeal wall, and the superior-based flap is elevated following splitting of the soft palate in the middle. The flap is folded with the mucosa outside. The mucosa on the ridge of the flap is denuded for attachment of the flap to the soft palate. Incisions are made in the nasal mucosa of the soft palate. In the case of a very short palate or in the case of poor mobility of the soft palate and pharyngeal walls, the incisions are extended toward the flap base [type III in Figure 2]. Sutures are placed between the flap and the soft palate from the lateral side to the medial side. In severe cases, sutures are placed around a 5 mm diameter suction tube. Finally, the soft palate is sutured.

Bottom Line: Velopharyngeal function is very important for patients with cleft palate to acquire good speech.The cases included 61 males and 36 females, ranging in age from 7 to 50 years.Approximately 95% of patients showed improved velopharyngeal function.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral Care for Systemic Health Support, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.

ABSTRACT

Background: Velopharyngeal function is very important for patients with cleft palate to acquire good speech. For patients with velopharyngeal insufficiency, prosthetic speech appliances and speech therapy are applied first, and then pharyngeal flap surgery to improve velopharyngeal function is performed in our hospital. The folded pharyngeal flap operation was first reported by Isshiki and Morimoto in 1975. We usually use a modification of the original method.

Purpose: The purpose of this research was to introduce our method of the folded pharyngeal flap operation and report the results.

Materials and methods: The folded pharyngeal flap operation was performed for 110 patients with velopharyngeal insufficiency from 1982 to 2010. Of these, the 97 whose postoperative speech function was evaluated are reported. The cases included 61 males and 36 females, ranging in age from 7 to 50 years. The time from surgery to speech assessment ranged from 5 months to 6 years. In order to evaluate preoperative velopharyngeal function, assessment of speech by a trained speech pathologist, nasopharyngoscopy, and cephalometric radiography with contrast media were performed before surgery, and then the appropriate surgery was selected and performed. Postoperative velopharyngeal function was assessed by a trained speech pathologist.

Results: Of the 97 patients who underwent the folded pharyngeal flap operation, 85 (87.6%) showed velopharyngeal competence, 8 (8.2%) showed marginal velopharyngeal incompetence, and only 2 (2.1%) showed velopharyngeal incompetence; in 2 cases (2.1%), hyponasality was present. Approximately 95% of patients showed improved velopharyngeal function.

Conclusions: The folded pharyngeal flap operation based on appropriate preoperative assessment has been shown to be an effective method for the treatment of cleft palate patients with velopharyngeal insufficiency.

No MeSH data available.


Related in: MedlinePlus