Gross Unilateral Abnormalities of the Velum and Pharynx

Abstract

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.

Unilateral Palatal Hypoplasia: A Case Report With a Long-Term Follow-Up

“…These procedures are generally static reconstructions. Mehendale and Sommerlad (2002) described three cases of gross unilateral abnormalities of the velum and pharynx and claimed the importance of functional reconstruction by radically dissecting and retropositioning the muscles of the non-affected side of the velum. However, all of these aforementioned cases were school children, and the follow-up periods after surgery were less than one year or were not mentioned.…”

“…We considered functional reconstruction to be the most important issue and therefore performed radical muscle retropositioning, as described by Mehendale and Sommerlad (2002), with a hemi-palatal mucoperiosteal flap. However, preoperative nasopharyngeal fiberscopy was not able to be performed due to her young age of one year old.…”

“…Asymmetric velopharyngeal incompetence (VPI) may be caused by neuromuscular disorders, trauma, tumor resection, cleft palate, or unilateral hypoplasia of the velum and pharynx (Mehendale and Sommerlad, 2002). Unilateral hypoplasia may occur in association with hemifacial microsomia; however, isolated unilateral palatal hypoplasia is extremely rare.…”

Craniomaxillofacial Abnormalities in Dogs With Congenital Palatal Defects: Computed Tomographic Findings

“…Minor degrees of velar asymmetry are not uncommon in patients with CL, CP, or both, and more severe degrees of velopharyngeal asymmetry may be present in patients with hemifacial microsomia. However, gross unilateral hypoplasia of the velum and pharynx in patients with no significant hemifacial microsomia or facial asymmetry is rare and probably a separate entity in people . Unilateral congenital soft palate hypoplasia is also rare in dogs and its development unknown …”

“…In veterinary medicine, the occurrence of CL and CP seems to be less common with 1.1 per 1,000 cases in beagles when bred as a pure strain . The precise cause of congenital palatal clefts and velopharyngeal hypoplasia (HP) is not entirely understood and several genetic and environmental factors are involved . Approximately two thirds or more of facial clefts in people are isolated anomalies (non‐syndromic clefts); however, >350 developmental syndromes associated with CL and CP have been identified .…”