title: Surgery for speech in cleft palate patients.
abstract: BACKGROUND
  Superiorly based pharyngeal flaps and sphincter pharyngoplasties are the two main possibilities for the surgical treatment of hypernasality in velopharyngeal dysfunction. Videonaspharyngoscopy and multi-view videofluoroscopy can provide anatomical and physiological data for planning these surgical procedures for correcting hypernasality.
  
  
  OBJECTIVE
  This study was undertaken to assess the planning and outcome of pharyngeal flaps and sphincter pharyngoplasties for correcting velopharyngeal insufficiency. The surgical techniques were customized according to the findings of videonasopharyngoscopy and multiview videofluoroscopy.
  
  
  METHODS
  Seventy patients with repaired palate clefts and residual velopharyngeal dysfunction were studied. The patients were randomly divided into two groups. The first group received a pharyngeal flap. The second group received a sphincter pharyngoplasty. Both procedures were individually customized according to the findings of videonasopharyngoscopy and multi-view videofluoroscopy.
  
  
  RESULTS
  There was a non-significant difference (P >0.05) between the mean size of preoperative velopharyngeal closure gap between the two groups of patients (mean=27.5%; S.D.=7.7% versus mean=28.3%; S.D.=5.9%). Postoperatively, velopharyngeal dysfunction was completely corrected in 89% of the cases from group 1, and in 85% of the cases from group 2. There was a non-significant difference (P >0.05) between the success rate for correcting VPI in both groups of patients.
  
  
  CONCLUSIONS
  Pharyngeal flap and sphincter pharyngoplasty seem to be safe and reliable procedures for treating residual velopharyngeal dysfunction. Although not all the patients studied for this paper achieved complete closure after the surgical procedures, all of them showed a reduction of the size of the velopharyngeal closure defect. The planning of the surgical procedure, in order to match the postoperative structure to the preoperative velopharyngeal dimensions and movements visualized through Videonasopharyngoscopy and videofluoroscopy, seems to be the most important aspect of the surgery for correcting residual velopharyngeal dysfunction.
authors.affiliation: Hospital Gea Gonzalez, 4800 Calzada Tlalpan, Mexico D.F. 14000, Mexico. amysunza@terra.com.mx
authors.forename: Antonio
authors.initials: A
authors.lastname: Ysunza
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Pamplona
authors.forename: Fernando
authors.initials: F
authors.lastname: Molina
authors.forename: Mónica
authors.initials: M
authors.lastname: Drucker
authors.forename: Jacobo
authors.initials: J
authors.lastname: Felemovicius
authors.forename: Elena
authors.initials: E
authors.lastname: Ramírez
authors.forename: Carmeluza
authors.initials: C
authors.lastname: Patiño
mesh_terms: D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications / Q000601:surgery*; D006761:Hospitals; D006801:Humans; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D013064:Speech Disorders / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000150:complications / Q000601:surgery