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A modified procedure for velopharyngeal sphincteroplasty in primary cleft palate repair and secondary velopharyngeal incompetence treatment and its preliminary results.
J Plast Reconstr Aesthet Surg 2006; 59(8):817-25JP

Abstract

During cleft repair, velopharyngeal sphincter reconstruction is still a challenge to plastic surgeons. To improve the surgical treatment for cleft palate and secondary velopharyngeal incompetence (VPI), a carefully designed modified procedure for primary palatoplasty and secondary VPI was presented. Fifty-six patients (48 for primary cleft palate repair and eight for secondary VPI of previously repaired clefts) underwent this procedure from 1988 to 2001. The modified procedure is a combination of the tunnelled palatopharyngeus myomucosal flap for dynamic circular reconstruction of the pharyngeal element of the velopharyngeal sphincter and the double-reversing Z-plasty with levator velo palatini muscles reposition in the velar element of the sphincter. The satisfactory velopharyngeal competence (complete velopharyngeal closure and marginal velopharyngeal closure) was achieved in 23 of 25 patients with primary cleft palate repair examined by nasendoscopy and the nasality, speech articulation and intelligibility are also assessed in 25 primary cleft palate repaired patients with 92% satisfactory result (normal speech and speech with mild VPI) in single word test and 88% in continuous speech evaluation. Based on our experience, we believe that this modified procedure is a reasonable choice for primary cleft repair and secondary VPI treatment because it is in accord with normal physiology and anatomy of the velopharyngeal sphincter, can lengthen the soft palate, decrease the enlarged velopharynx, augment the posterior pharyngeal wall, and enhance the relationship between the muscles of velopharyngeal sphincter which results in a dynamic neo-sphincter in palatopharyngoplasty. Further study of the procedure is needed. The theoretical basis, operative highlights, velopharyngeal function, advantages and disadvantages of the modified procedure were discussed.

Authors+Show Affiliations

Department of Plastic Surgery, Guangzhou Medical College, Guangzhou First Municipal People's Hospital, 1 Panfu Road, Guangzhou 510180, People's Republic of China. chengningxin@163.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16876078

Citation

Cheng, Ningxin, et al. "A Modified Procedure for Velopharyngeal Sphincteroplasty in Primary Cleft Palate Repair and Secondary Velopharyngeal Incompetence Treatment and Its Preliminary Results." Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, vol. 59, no. 8, 2006, pp. 817-25.
Cheng N, Zhao M, Qi K, et al. A modified procedure for velopharyngeal sphincteroplasty in primary cleft palate repair and secondary velopharyngeal incompetence treatment and its preliminary results. J Plast Reconstr Aesthet Surg. 2006;59(8):817-25.
Cheng, N., Zhao, M., Qi, K., Deng, H., Fang, Z., & Song, R. (2006). A modified procedure for velopharyngeal sphincteroplasty in primary cleft palate repair and secondary velopharyngeal incompetence treatment and its preliminary results. Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, 59(8), pp. 817-25.
Cheng N, et al. A Modified Procedure for Velopharyngeal Sphincteroplasty in Primary Cleft Palate Repair and Secondary Velopharyngeal Incompetence Treatment and Its Preliminary Results. J Plast Reconstr Aesthet Surg. 2006;59(8):817-25. PubMed PMID: 16876078.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A modified procedure for velopharyngeal sphincteroplasty in primary cleft palate repair and secondary velopharyngeal incompetence treatment and its preliminary results. AU - Cheng,Ningxin, AU - Zhao,Min, AU - Qi,Kemin, AU - Deng,Hui, AU - Fang,Zeng, AU - Song,Ruyao, Y1 - 2006/02/02/ PY - 2004/05/11/received PY - 2005/07/25/revised PY - 2005/11/01/accepted PY - 2006/8/1/pubmed PY - 2006/10/13/medline PY - 2006/8/1/entrez SP - 817 EP - 25 JF - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JO - J Plast Reconstr Aesthet Surg VL - 59 IS - 8 N2 - During cleft repair, velopharyngeal sphincter reconstruction is still a challenge to plastic surgeons. To improve the surgical treatment for cleft palate and secondary velopharyngeal incompetence (VPI), a carefully designed modified procedure for primary palatoplasty and secondary VPI was presented. Fifty-six patients (48 for primary cleft palate repair and eight for secondary VPI of previously repaired clefts) underwent this procedure from 1988 to 2001. The modified procedure is a combination of the tunnelled palatopharyngeus myomucosal flap for dynamic circular reconstruction of the pharyngeal element of the velopharyngeal sphincter and the double-reversing Z-plasty with levator velo palatini muscles reposition in the velar element of the sphincter. The satisfactory velopharyngeal competence (complete velopharyngeal closure and marginal velopharyngeal closure) was achieved in 23 of 25 patients with primary cleft palate repair examined by nasendoscopy and the nasality, speech articulation and intelligibility are also assessed in 25 primary cleft palate repaired patients with 92% satisfactory result (normal speech and speech with mild VPI) in single word test and 88% in continuous speech evaluation. Based on our experience, we believe that this modified procedure is a reasonable choice for primary cleft repair and secondary VPI treatment because it is in accord with normal physiology and anatomy of the velopharyngeal sphincter, can lengthen the soft palate, decrease the enlarged velopharynx, augment the posterior pharyngeal wall, and enhance the relationship between the muscles of velopharyngeal sphincter which results in a dynamic neo-sphincter in palatopharyngoplasty. Further study of the procedure is needed. The theoretical basis, operative highlights, velopharyngeal function, advantages and disadvantages of the modified procedure were discussed. SN - 1748-6815 UR - https://www.unboundmedicine.com/medline/citation/16876078/A_modified_procedure_for_velopharyngeal_sphincteroplasty_in_primary_cleft_palate_repair_and_secondary_velopharyngeal_incompetence_treatment_and_its_preliminary_results_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1748-6815(05)00416-X DB - PRIME DP - Unbound Medicine ER -