title: Levatorplasty, a new technique to treat hypernasality: anatomical investigations and preliminary clinical results.
abstract: BACKGROUND
  Velopharyngoplasty is the most commonly used operative technique for the treatment of velopharyngeal insufficiency. By attaching a posterior pharyngeal flap to the velum, a nonphysiological situation is created in the upper airway.
  
  
  OBJECTIVE
  The aim of this investigation was to find a new surgical approach to physiological reconstruction of the velopharyngeal sphincter.
  
  
  METHODS
  Anatomical investigations were performed in four cadavers. From this study a new surgical technique was developed and called 'levatorplasty': the musculus longus capitis was taken to create a new muscular loop leading to (a) an augmentation of the posterior wall, (b) a medial shift of the lateral pharyngeal wall; and (c) stretching of the velum posteriorly. Thus, the velopharyngeal space was reduced and a physiological closure of the nasal airway space could be obtained.
  
  
  METHODS
  The levatorplasty was employed in nine cleft palate patients with velopharyngeal insufficiency. Pre- and postoperatively the velopharyngeal closure was evaluated by phonetic and radiological examination.
  
  
  RESULTS
  The operation was easily performed without major complications. A concentric constriction with decrease of the velopharyngeal space was achieved and a definitive decrease of nasalance and hypernasality resulted.
  
  
  CONCLUSIONS
  Long-term follow-ups have to verify whether these results will be stable. They also have to be compared with functional improvements following velopharyngoplasty or pharyngoplasty. Of special interest will be evaluation of the altered mobility of the lateral pharyngeal walls.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Technology Munich, Germany. sader@mkg.med.tu-muenchen.de
authors.forename: R
authors.initials: R
authors.lastname: Sader
authors.forename: H F
authors.initials: HF
authors.lastname: Zeilhofer
authors.forename: R
authors.initials: R
authors.lastname: Putz
authors.forename: H H
authors.initials: HH
authors.lastname: Horch
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D006801:Humans; D009334:Neck Muscles / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000379:methods*; D010160:Palate, Soft / Q000601:surgery; D010609:Pharyngeal Muscles / Q000601:surgery*; D014681:Velopharyngeal Insufficiency / Q000601:surgery*; D014832:Voice Disorders / Q000601:surgery*; D014833:Voice Quality