Cleft Palate Repair and Velopharyngeal Dysfunction

Abstract

Goals of a successful cleft palate repair include separation of the oral and nasal components without fistula, achieving sufficient velar length, and creating functional transverse orientation of the levator muscle sling. A number of techniques have been described to achieve these goals, but they all have the following technical details in common: elevation of oral mucosal flaps based on the greater palatine arteries, tension free nasal lining mobilization, and functional intervelar muscle dissection. After palate repair, speech evaluation needs to be performed by an objective interdisciplinary team following a standardized protocol. Identification of velopharyngeal insufficiency secondary to an incompetent nasopharyngeal port will necessitate secondary speech surgery. These secondary techniques include pharyngeal flaps, soft palate lengthening, or pharyngeal sphincters, which should be tailored to optimize speech, while minimizing the risk of obstructive sleep apnea.

Nasoendoscopic findings after primary palatal surgery: can the Furlow technique result in a smaller velopharyngeal gap?

“…This study did not involve the conduction of perceptual evaluation of speech samples obtained during the nasoendoscopic exam. It is suggested that this limitation should be better controlled in future studies because the use of compensatory articulation and the presence of hypernasality and nasal air escape may interfere with the movement of velopharyngeal structures (1,12) .…”

“…The velopharyngeal function can be affected by vocal intensity and by the different levels of intraoral and subglottic pressure used by speakers during speech production (1,4,12) . This study did not involve the conduction of perceptual evaluation of speech samples obtained during the nasoendoscopic exam.…”

“…The F technique, for example, stretches the soft palate through two mirrored zetaplasties involving oral and nasal flaps (mirrored between planes) with transposition of the flaps, which involves muscular retroposing (2,6,12) . However, the vL technique with intravelar veloplasty requires the release and thorough dissection of the muscles, also allowing posteriorization of the muscle fibers (6,11,22) .…”

“…The repair of cleft palate was first described by von Langenbeck (vL) in 1861, whose technique, which is named after him, highlights the importance of the separation of the oral and nasal cavities, principle used in most of the techniques to date (6,11,12) . Many authors pointed out that the disadvantage of this technique is that it does not lengthen the palate sufficiently for the reconstruction of the VPM (6,13) .…”

Achados videofluoroscópicos das estruturas velofaríngeas após a cirurgia primária do palato

“…Por outro lado, postergá-lo pode afetar diretamente o desenvolvimento da fala (HENNINGSSON et al, 2008;AGRAWAL, 2009;MITUUTI et al, 2010;BISPO et al, 2011;WILLIAMS et al, 2011;HORTIS-DZIERZBICKA;RADKOWSKA;FUDALEJ, 2012;ABDEL-AZIZ, 2013;CHEN et al, 2013;GUNDLACH et al, 2013;HOPPER et al, 2014;RANDAG;DREISE;RUETTERMANN, 2014). A maioria dos centros mundialmente realiza a palatoplastia entre 6 e 12 meses de idade, pois nesta faixa etária a criança encontrase no início da aquisição de linguagem (ANDRADES et al, 2008;AGRAWAL, 2009;KATZEL et al, 2009;GONGORJAV et al, 2012;ABDEL-AZIZ, 2013;CHEN et al, 2013;HOPPER et al, 2014).…”