title: Results of speech improvement following simultaneous push-back together with velopharyngeal flap surgery in cleft palate patients.
abstract: OBJECTIVE
  Velopharyngeal insufficiency (VPI) can be caused by a variety of disorders. The most common cause of VPI is the association with cleft palate. The aim of this study was to evaluate the effectiveness of different surgical techniques for cleft palate patients with VPI: (1) velopharyngoplasty with an inferiorly based posterior pharyngeal flap (VPP posterior, Schönborn-Rosenthal), and (2) combination of VPP posterior and push-back operation (Dorrance).
  
  
  METHODS
  41 subjects (26 females, 15 males) with VPI were analysed. Hypernasality was judged subjectively and nasalance data were assessed objectively using the NasalView system preoperative and 6 months postoperative.
  
  
  RESULTS
  Subjective analysis showed improved speech results regarding hypernasality for all OP-techniques with good results for VPP posterior and VPP posterior combined with push-back with success rates of 94.4% and 87.7%, respectively. Objective analysis showed a statistically significant reduction of nasalance for both VPP posterior and VPP posterior combined with push-back (p < 0.01). However, there were no statistically significant differences concerning measured nasalance values postoperatively between the VPP posterior and VPP posterior combined with push-back.
  
  
  CONCLUSIONS
  Based on our findings, both VPP posterior and VPP posterior combined with push-back showed good results in correction of hypernasality in cleft patients with velopharyngeal insufficiency.
authors.affiliation: Fachklinik Hornheide, Department of Cranio-Maxillofacial Surgery, Dorbaumstrasse 300, 48157 Muenster, Germany. Electronic address: kai.wermker@fachklinik-hornheide.de.
authors.forename: Kai
authors.initials: K
authors.lastname: Wermker
authors.affiliation: Fachklinik Hornheide, Department of Cranio-Maxillofacial Surgery, Dorbaumstrasse 300, 48157 Muenster, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Lünenbürger
authors.affiliation: University Hospital Münster, Department of Cranio-Maxillofacial Surgery, Waldeyerstraße 30, 48149 Muenster, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Joos
authors.affiliation: University Hospital Münster, Department of Cranio-Maxillofacial Surgery, Waldeyerstraße 30, 48149 Muenster, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kleinheinz
authors.affiliation: University Hospital Münster, Department of Cranio-Maxillofacial Surgery, Waldeyerstraße 30, 48149 Muenster, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Jung
mesh_terms: D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010160:Palate, Soft / Q000503:physiopathology / Q000601:surgery; D010609:Pharyngeal Muscles / Q000503:physiopathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013060:Speech / Q000502:physiology*; D013064:Speech Disorders / Q000175:diagnosis / Q000628:therapy; D013524:Surgical Flaps / Q000601:surgery*; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery*
keywords: Cleft palate; Hypernasality; Surgical treatment; Velopharyngeal insufficiency; Velopharyngoplasty