Long-term follow-up after division of a pharyngeal flap for severe nasal obstruction.

Between 1965 and 1986, nine patients were noticed to have significant nasal airway obstruction following surgery for velopharyngeal incompetence (VPI). All had a superiorly based pharyngeal flap. Division of the flap was recommended to correct the posterior obstruction. A complete section of the flap was done in seven cases and lateral port enlargement was done in the remaining two. The interval between flap elevation and transection ranged from 5 months to 5 years. Three patients required more than one operation to fully correct the obstruction. All the patients were evaluated 2 to 14 years later to assess nasal breathing and speech and to document velopharyngeal function by nasoendoscopy and video-fluoroscopy. One patient presented major symptoms of nasal obstruction at follow-up, while other reported snoring and occasional mouth breathing, although their nasal respiration appeared subjectively adequate. Four patients had normal speech, three were mildly hyponasal, one was moderately hyponasal, and the other was severely hyponasal. Intelligibility was good in all cases but one, although three patients had some articulation errors: two with persistent errors related to early VPI and one from dental malocclusion and tongue protrusion. Videofluoroscopy and nasoendoscopy showed that despite complete transection at the base of the flap in eight cases, five still had evidence of residual tethering. In one patient, the obstruction was almost complete and repeat division of the flap was recommended. Seven patients showed increased thickness of the soft palate in the midline where the flap had been anchored.(ABSTRACT TRUNCATED AT 250 WORDS)

[Is velopharyngeal competence stable with growth in patients with cleft palate?]. / La compétence vélopharyngée est-elle stable avec la croissance chez les patients porteurs de fente palatine?

It is possible to have a good velopharyngeal closure at 8 years of age and slowly deteriorate to present with velopharyngeal incompetence (VPI) at adolescence? Authors disagree on this subject so we undertook a study to find the answer in our cleft palate population. One hundred and seventy-three patients born between 1968 and 1972 with a cleft palate or cleft lip and palate were reviewed. The appreciation of their velopharyngeal closure at 8 years of age, as rated in their chart, was classified as good (group I, 125 patients), borderline (group II, 17 patients) or incompetent (group III, 35 patients). All children in group I had a good velopharyngeal closure before the age of 8 years, some never presented any symptoms of incompetency (VPI) while other corrected this VPI before the age of 8. The group II included children presenting inconstant or mild symptoms of VPI. All patients in group III received a pharyngeal flap to correct their VPI and were not included in this follow up study. Groups I and II were recalled and 52 presented for a late clinical evaluation of their speech. Group I: 47 examined, 42 still competent, 5 incompetent: group II: 5 examined, 3 competent and 2 incompetent. It is interesting to note that in group I, all five deteriorations of the V-P competency was seen in patients who had shown some symptoms of VPI in early childhood. They had become competent spontaneously or with speech therapy, before age 8.(ABSTRACT TRUNCATED AT 250 WORDS)