[Surgical treatment of severe velopharyngeal insufficiency following uvulopalatopharyngoplasty (UPPP)].
BACKGROUND
For the implementation of an uvulopalatopharyngoplasty (UPPP) it is nowadays common practice to operate in a manner which is gentle on the tissue and which retains as much muscle as possible. However, even when the greatest possible care is taken during the operation, serious complications such as persistent velopharyngeal insufficiency can arise.


METHODS
Based on a case report of a 55 year old man with a persistent severe velopharyngeal insufficiency after UPPP performed at another institution and serious OSA, we suggest a so-called push back technique, adapted from the cleft-palate surgery, for the extension of the soft-palate. With regard to the operative technique, it is thus possible to produce an effective extension of the soft-palate by means of a dorsocaudal displacement of a wide and on the palatal vascular fascicle pedicled mucoperiosteum flap of the mucous membrane of the hard palate, as well as similar mobilisation of the soft-palate from the os-palatinum.


RESULTS
Only 3 weeks after the operation, our patient showed a clinically sufficient velopharyngeal functioning. After 3 months, a complete restoration of the nasal CPAP-acceptance was evident. As a result, a complete social rehabilitation was possible for our patient.


CONCLUSIONS
The modified push back technique of the palate retrodisplacement which is described above offers an efficient possibility of anatomically and functionally correcting the persistent and serious velopharyngeal insufficiency after UPPP.
Magritz
R
R
Klinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, Prospe-Hospital, Akademisches Lehrkrankenhaus der Ruhruniversität Bochum, Recklinghausen.
Siegert
R
R
D003680:Deglutition Disorders / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010159:Palate / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D013524:Surgical Flaps; D013536:Suture Techniques; D014609:Uvula / Q000601:surgery*; D014681:Velopharyngeal Insufficiency / Q000601:surgery*