A new operation to cure nasopharyngeal incompetence

Ft, Moore

doi:10.1002/bjs.18004720419

Cited by 29 publications

(8 citation statements)

References 3 publications

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“…79 Goals of this procedure include obliteration of the lateral pharyngeal recesses, increase tissue bulk on the nasal surface of the velum at the point of potential contact of the velum with the posterior pharyngeal wall, and possibly velar lengthening. Mehendale and Sommerlad 78 described the use of a unilateral Moore pharyngoplasty flap to support the non-functioning or poorly functioning side of the velum, thereby assisting the active contralateral levator to elevate the entire velum.…”

Section: Management Of Unilateral or Asymmetric Velopharyngeal Insuffmentioning

confidence: 99%

Cleft palate and velopharyngeal dysfunction

Cugno

Sommerlad

2015

Plastic and Reconstructive Surgery

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Section: Management Of Unilateral or Asymmetric Velopharyngeal Insuffmentioning

confidence: 99%

Cleft palate and velopharyngeal dysfunction

Cugno

Sommerlad

2015

Plastic and Reconstructive Surgery

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“…A palate re-repair (Sommerlad et al, 1994(Sommerlad et al, , 2001) and a left posterolateral pharyngeal flap (modified Moore pharyngoplasty; Moore, 1960) were performed. As in case 1, the intraoperative findings (Fig.…”

Section: Casementioning

confidence: 99%

“…The muscle and tensor aponeurosis on the right were divided from the back of the hard palate and radically mobilized and retropositioned (Sommerlad et al, 1994(Sommerlad et al, , 2001). The rudimentary left hemivelum was lengthened with a modified Moore pharyngoplasty (Moore, 1960) by raising a flap, based high on the left posterolateral pharyngeal wall and insetting it into the nasal mucosa on the left side of the velum. The mobilized muscle from the right side was sutured across the midline to soft tissues in the left side of the velum.…”

Section: Casementioning

confidence: 99%

See 1 more Smart Citation

Gross Unilateral Abnormalities of the Velum and Pharynx

Mehendale

Sommerlad

2002

The Cleft Palate Craniofacial Journal

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Objective Velopharyngeal incompetence because of gross unilateral velopharyngeal hypoplasia is rare, particularly in patients with no significant hemifacial microsomia or facial asymmetry. We describe the abnormal anatomy and treatment of three patients with gross congenital velopharyngeal asymmetry. Results and Conclusions Following surgery, all three patients showed a good improvement in velopharyngeal function and speech. Nasendoscopy and lateral videofluoroscopy were important in confirming the abnormal anatomy and pathology and in evaluating the degree of movement of the affected side of the velum and pharyngeal walls as well as the size and location of the defect. Muscles from the normal side were radically dissected and mobilized across the midline to reconstruct the hypoplastic hemivelum. Mucosal lengthening was achieved by suturing the normal mucosa to the mucosa of the hypoplastic hemivelum and the lateral pharyngeal wall or by insetting a posterolateral pharyngeal flap (modified Moore pharyngoplasty) into the nasal surface of the hypoplastic side.

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“…(i) Inferiorly based (Schoenborn, 1872;Rosenthal, 1924) (ii) Superiorly based (Sanvenero and Rosselli, 1934) (iii) Superiorly based bilateral flaps (Rethi, 1932) and lateral pharyngoplasty (Moore, 1960) (iv) Double posterior flaps, one superiorly based and the other inferiorly based (Millard, 1962) (v) Palmaris longus transplantation (Inchul and Bomberg, 1974) Dynamic corrections (a) Pharyngoplasty by muscle transplantation (Hynes, 1950) (b) Dynamic muscle transplant operation (Ghosh et al, 1972) Statico-dynamic concentrations (a) Dynamic muscle sphincter operation (Ortichochea, 1970) (b) Statico-dynamic palatopharyngoplasty (Ghosh, 1973) (c) Transverse palatopharyngoplasty (Ghosh, 1976a) (d) Levator palati transplantation (Edgerton and Dellon, 1971;Ghosh, 1977a) (e) Combined Approach Palatopharyngoplasty (CAP) (Ghosh, 1978) by dextrous rerouting of the palatopharyngeus and salpingopharyngeus muscle complex. But in Ortichochea's dynamic muscle sphincter operation (1970) this action appears to be accentuated to the extent of producing a sort of restraint band, as mentioned by Weber et al (1970) in connection with Rosenthal's operation.…”

Section: Phonosurgerymentioning

confidence: 99%

Phonosurgery

Ghosh¹

1980

J. Laryngol. Otol.

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A new surgical approach (CAP--Combined Approach Palatopharyngoplasty) is described for the correction of speech defects in palatopharyngeal incompetence. In palatopharyngeal incompetence the spatial relationships between the various components of the palatopharyngeal mechanism are disturbed. This combined approach brings about near-normal relationships (viz. intrapalatal and palatopharyngeal), as well as providing a competent palatopharyngeal sphincter, thus offering a remarkable improvement in speech. The operation comprises a two-stage procedure: stage I:--(a) submucosal transplantation of the levator palati muscles posteriorly to the region of the uvula and (b) 'crossed' palatopharyngoplasty; isolation of the palatopharyngeus muscles (posterior pillars) with their bases superiorly placed at their junctions with the soft palate, and transplantation of the lower free ends into the transverse retropharyngeal musculo-fascial pockets on the opposite side, the flaps thus crossing each other in the midline: stage II:--'check-valve' palatopharyngoplasty; elevation of a superiorly based posterior pharyngeal flap with anastomosis to the soft palate. The dynamics which are responsible for the improvement in speech are: (a) elevation of the palate to about the level of the atlas; (b) statico-dynamic constriction of the pharyngeal phonetic passage at the following levels: (i) at the newly placed levator eminence, (ii) at the newly constructed dynamic sphincter situated between the above-mentioned crossing and the free margin of the soft palate, and (iii) at the junction of the check-valve flap with the posterior pharyngeal wall; (c) increase in the effective length of the soft palate. The phonetic stream is prevented from entering the nasal chambers during the utterance of non-nasal pressure sounds by the newly constructed three-tier protective mechanism. This is identical with, but a 'reverse' representation of, the normal three-tier protective mechanism of the larynx, which prevents food from entering the tracheo-broncheal tree during deglutition. The operation has been performed in eight cases and the results are satisfactory, in so far as improvement in the quality of speech is better than that observed following other operations. In conclusion, the principles of phonosurgery may well be diagrammatically represented in Fig. 7.

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A new operation to cure nasopharyngeal incompetence

Cited by 29 publications

References 3 publications

Cleft palate and velopharyngeal dysfunction

Cleft palate and velopharyngeal dysfunction

Gross Unilateral Abnormalities of the Velum and Pharynx

Phonosurgery

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