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Surgical Management of the Hypodynamic Palate

Surgical Management of the Hypodynamic Palate Abstract • The most successful surgical correction of velopharyngeal insufficiency (VPI) has been achieved in those patients in whom residual dynamic function of the soft palate/nasopharyngeal sphincter mechanism exists. In spite of the obvious need for rehabilitation, surgical reconstruction has often been advised against in those cases where the palate was hypodynamic or adynamic. We have developed a surgical procedure for these patients by utilizing a modification of Hogan's lateral port control pharyngeal flap method. We present the surgical considerations along with the initial application and results in four patients with hypodynamic palates of differing origins. We think that this technique extends surgical correction of VPI to the previously neglected group of patients in whom this condition is the result of a hypodynamic palate. (Arch Otolaryngol 105:347-350, 1979) References 1. Hogan VM, Schwartz MF: Velopharyngeal incompetence , in Converse JM (ed): Reconstructive Plastic Surgery , ed 2. Philadelphia, WB Saunders Co, 1977, vol 4, chap 52, p 2279. 2. Randall P: Cleft palate , in Grabb WC, Smith JW (eds): Plastic Surgery . Boston, Little Brown & Co, 1973, p 202. 3. Cotton RC: Velopharyngeal Insufficiency . Instructional course to American Academy of Ophthalmology and Otolaryngology, Dallas, (Oct 13) , 1977. 4. Veau V: Les résultats anatomiques et fonctionnels de la staphglorraphie par les procédés classiques . Rev Chir , No. (2) , 1922, pp 81-99. 5. Wardill WEM: Technique of operation for cleft palate . Br J Surg 25:117-130, 1938.Crossref 6. Dorrance GM: Lengthening the soft palate in cleft palate operations . Ann Surg 82:208-211, 1925.Crossref 7. Peet E: The Oxford technique of cleft palate repair . Plast Reconstr Surg 28:282-294, 1961.Crossref 8. Steffenson WH: Palate lengthening operations . Plast Reconstr Surg 10:380-387, 1952.Crossref 9. Millard DR: Wide and/or short cleft palate . Plast Reconstr Surg 29:40-57, 1962.Crossref 10. Ganguli AC: Lengthening the soft palate by submucous cheek pedicle flaps , in Hueston JT (ed): Transactions of the Fifth International Congress of Plastic and Reconstructive Surgery . Melbourne, Butterworth & Co, 1971. 11. Moore FT, Chong JK: The "sandwich" technique to lengthen the soft palate . Br J Oral Surg 4:183-188, 1967.Crossref 12. Lively debate breaks out over plastic surgery techniques, MEDICAL NEWS . JAMA 216:2075-2082, 1971.Crossref 13. Eckstein H: Demonstration of paraffin prosthesis in defects of the face and palate . Dermatologica 11:772-787, 1904.Crossref 14. Von Gaza WV: Über freie Fettgewebstranplantation in den Retropharyngealen raum bei Gaumenspalte . Arch Klin Chir 142:590-603, 1926. 15. Lando RL: Transplant of cadaveric cartilage into the posterior pharyngeal wall in treatment of cleft palate . Stomatologiia 4:38-46, 1950. 16. Hollweg E, Perthes G: in Wagner E (ed): Treatment of Cleft Palates . Tübingen, West Germany, Franz Pietzcher, 1912. 17. Hill MJ, Hagerty RF: Efficacy of pharyngoplasty for speech improvement in postoperative cleft palates . Cleft Palate Bull 10:66-73, 1960. 18. Halle H: Gaumennaht and Gaumenenplastik . Arch Ohr Nasen Kehlkopfheilk 12:377-384, 1925. 19. Blocksma R: Correction of velopharyngeal insufficiency by Silastic pharyngeal implant . Plast Reconstr Surg 31:268-274, 1963.Crossref 20. Brauer RO, cited by Hogan VM, Schwartz MF: Velopharyngeal incompetence , in Converse JM (ed): Reconstructive Plastic Surgery , ed 2. Philadelphia, WB Saunders Co, 1977, chap 52, p 2274. 21. Ward PH: Uses of injectable Teflon in otolaryngology . Arch Otolaryngol 87:637-643, 1968.Crossref 22. Bluestone CD, Musgrave RH, McWilliams BJ, et al: Teflon injection pharyngoplasty . Cleft Palate J 5:19-22, 1968. 23. Hynes W: Pharyngoplasty by muscle transplantation . Br J Plast Surg 3:128-135, 1950.Crossref 24. Passavant G: Über die Operation der angeborenen Spalten des hartem Ganmens und der darnit complicierten Hasenscharten . Arch Ohr Nasen Kehlkopfheilk 3:193-207, 1862. 25. Sullivan DE: Bilateral pharyngoplasty as an aid to velopharyngeal closure . Plast Reconstr Surg 27:31-39, 1961.Crossref 26. Braithewaite F: The importance of the levator palati muscle in cleft palate closure . Br J Plast Surg 21:60-62, 1968.Crossref 27. Browne D: An orthopaedic operation for cleft palate . Br Med J 20:1093-1097, 1935.Crossref 28. Thompson N: A review of autogenous skeletal muscle grafts and their application . Clin Plast Surg 1:349-403, 1974. 29. Padgett EC: The repair of cleft palates after unsuccessful operations, with special reference to cases with an extensive loss of palatal tissue . Arch Surg 20:453-472, 1930.Crossref 30. Sanvenero-Roselli G: Divisione palatine e sua cura chirurgica . Atti Congr Int Stomatol , 1935, p 391. 31. Stark RB, DeHaan C: The addition of a pharyngeal flap to primary palatoplasty . Plast Reconstr Surg 26:378-387, 1960.Crossref 32. Hogan VM: A clarification of the surgical goals in cleft palate speech and the introduction of the lateral port control (LPC) pharyngeal flap . Cleft Palate J 10:331-345, 1973. 33. Ishiki N, Honjow L, Morimoto M: Effects of velopharyngeal incompetence on speech . Cleft Palate J 5:297-310, 1968. 34. Bjork L: Velopharyngeal function in connected speech . Acta Radiol , (suppl 202) , 1961. 35. Warren DW, Devereux JL: An analog study of cleft palate speech . Cleft Palate J 3:103-114, 1966. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology American Medical Association

Surgical Management of the Hypodynamic Palate

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1979 American Medical Association. All Rights Reserved.
ISSN
0003-9977
DOI
10.1001/archotol.1979.00790180045009
Publisher site
See Article on Publisher Site

Abstract

Abstract • The most successful surgical correction of velopharyngeal insufficiency (VPI) has been achieved in those patients in whom residual dynamic function of the soft palate/nasopharyngeal sphincter mechanism exists. In spite of the obvious need for rehabilitation, surgical reconstruction has often been advised against in those cases where the palate was hypodynamic or adynamic. We have developed a surgical procedure for these patients by utilizing a modification of Hogan's lateral port control pharyngeal flap method. We present the surgical considerations along with the initial application and results in four patients with hypodynamic palates of differing origins. We think that this technique extends surgical correction of VPI to the previously neglected group of patients in whom this condition is the result of a hypodynamic palate. (Arch Otolaryngol 105:347-350, 1979) References 1. Hogan VM, Schwartz MF: Velopharyngeal incompetence , in Converse JM (ed): Reconstructive Plastic Surgery , ed 2. Philadelphia, WB Saunders Co, 1977, vol 4, chap 52, p 2279. 2. Randall P: Cleft palate , in Grabb WC, Smith JW (eds): Plastic Surgery . Boston, Little Brown & Co, 1973, p 202. 3. Cotton RC: Velopharyngeal Insufficiency . Instructional course to American Academy of Ophthalmology and Otolaryngology, Dallas, (Oct 13) , 1977. 4. Veau V: Les résultats anatomiques et fonctionnels de la staphglorraphie par les procédés classiques . Rev Chir , No. (2) , 1922, pp 81-99. 5. Wardill WEM: Technique of operation for cleft palate . Br J Surg 25:117-130, 1938.Crossref 6. Dorrance GM: Lengthening the soft palate in cleft palate operations . Ann Surg 82:208-211, 1925.Crossref 7. Peet E: The Oxford technique of cleft palate repair . Plast Reconstr Surg 28:282-294, 1961.Crossref 8. Steffenson WH: Palate lengthening operations . Plast Reconstr Surg 10:380-387, 1952.Crossref 9. Millard DR: Wide and/or short cleft palate . Plast Reconstr Surg 29:40-57, 1962.Crossref 10. Ganguli AC: Lengthening the soft palate by submucous cheek pedicle flaps , in Hueston JT (ed): Transactions of the Fifth International Congress of Plastic and Reconstructive Surgery . Melbourne, Butterworth & Co, 1971. 11. Moore FT, Chong JK: The "sandwich" technique to lengthen the soft palate . Br J Oral Surg 4:183-188, 1967.Crossref 12. Lively debate breaks out over plastic surgery techniques, MEDICAL NEWS . JAMA 216:2075-2082, 1971.Crossref 13. Eckstein H: Demonstration of paraffin prosthesis in defects of the face and palate . Dermatologica 11:772-787, 1904.Crossref 14. Von Gaza WV: Über freie Fettgewebstranplantation in den Retropharyngealen raum bei Gaumenspalte . Arch Klin Chir 142:590-603, 1926. 15. Lando RL: Transplant of cadaveric cartilage into the posterior pharyngeal wall in treatment of cleft palate . Stomatologiia 4:38-46, 1950. 16. Hollweg E, Perthes G: in Wagner E (ed): Treatment of Cleft Palates . Tübingen, West Germany, Franz Pietzcher, 1912. 17. Hill MJ, Hagerty RF: Efficacy of pharyngoplasty for speech improvement in postoperative cleft palates . Cleft Palate Bull 10:66-73, 1960. 18. Halle H: Gaumennaht and Gaumenenplastik . Arch Ohr Nasen Kehlkopfheilk 12:377-384, 1925. 19. Blocksma R: Correction of velopharyngeal insufficiency by Silastic pharyngeal implant . Plast Reconstr Surg 31:268-274, 1963.Crossref 20. Brauer RO, cited by Hogan VM, Schwartz MF: Velopharyngeal incompetence , in Converse JM (ed): Reconstructive Plastic Surgery , ed 2. Philadelphia, WB Saunders Co, 1977, chap 52, p 2274. 21. Ward PH: Uses of injectable Teflon in otolaryngology . Arch Otolaryngol 87:637-643, 1968.Crossref 22. Bluestone CD, Musgrave RH, McWilliams BJ, et al: Teflon injection pharyngoplasty . Cleft Palate J 5:19-22, 1968. 23. Hynes W: Pharyngoplasty by muscle transplantation . Br J Plast Surg 3:128-135, 1950.Crossref 24. Passavant G: Über die Operation der angeborenen Spalten des hartem Ganmens und der darnit complicierten Hasenscharten . Arch Ohr Nasen Kehlkopfheilk 3:193-207, 1862. 25. Sullivan DE: Bilateral pharyngoplasty as an aid to velopharyngeal closure . Plast Reconstr Surg 27:31-39, 1961.Crossref 26. Braithewaite F: The importance of the levator palati muscle in cleft palate closure . Br J Plast Surg 21:60-62, 1968.Crossref 27. Browne D: An orthopaedic operation for cleft palate . Br Med J 20:1093-1097, 1935.Crossref 28. Thompson N: A review of autogenous skeletal muscle grafts and their application . Clin Plast Surg 1:349-403, 1974. 29. Padgett EC: The repair of cleft palates after unsuccessful operations, with special reference to cases with an extensive loss of palatal tissue . Arch Surg 20:453-472, 1930.Crossref 30. Sanvenero-Roselli G: Divisione palatine e sua cura chirurgica . Atti Congr Int Stomatol , 1935, p 391. 31. Stark RB, DeHaan C: The addition of a pharyngeal flap to primary palatoplasty . Plast Reconstr Surg 26:378-387, 1960.Crossref 32. Hogan VM: A clarification of the surgical goals in cleft palate speech and the introduction of the lateral port control (LPC) pharyngeal flap . Cleft Palate J 10:331-345, 1973. 33. Ishiki N, Honjow L, Morimoto M: Effects of velopharyngeal incompetence on speech . Cleft Palate J 5:297-310, 1968. 34. Bjork L: Velopharyngeal function in connected speech . Acta Radiol , (suppl 202) , 1961. 35. Warren DW, Devereux JL: An analog study of cleft palate speech . Cleft Palate J 3:103-114, 1966.

Journal

Archives of OtolaryngologyAmerican Medical Association

Published: Jun 1, 1979

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