Palatal bone distraction an option for velopharyngeal incompetency after repeatedly failed velopharyngeal flap surgery

Background and objectives: A Stickler Syndrome patient with a surgically repaired cleft palate was referred to Facial Cleft Deformity Clinic after he received previously repeated velopharyngeal flaps and still had a speech problem. The largest Facial Cleft Deformity Unit in Africa and IAOMS Training Fellowship Centre (University of Pretoria) with 3791 cleft patients, has 2969 (78.3%) cleft soft palate cases, which presents in various categories of cleft lip and palate. The purpose of this study is to assess an alternative surgical application of palatal bone distraction in treating velopharyngeal incompetency (VPI), as well as the post-surgical effect of velopharyngeal competency evaluated by speech therapy, fluorographic and cephalometric examination.

Methods: Palatal distraction involves a palatal bone osteotomy in the form of a square ‘horseshoe’, which leaves the palatal nerve and vascular bundle intact. A commercially available intraoral distraction apparatus is used. During the distraction procedure the distal bone segment is repositioned posteriorly, therefore lengthening the bony palate and as such moving the soft palate posteriorly. The velopharyngeal competency is assessed by the communication pathologist and compared with the fluorographic examination.

Results: Speech improves with this procedure, however, the palatal distraction is limited to cases with no or partial bony cleft mainly found in isolated soft palate cleft. This limitation applies as there should be a bony bridge between the two palatal shelves for the attachment and stability of the distraction apparatus. Only six cases with persisting VPI of 2969 soft palate clefts were corrected by this surgical procedure.

Conclusion: The palatal bone distraction for velopharyngeal incompetency after failed velopharyngeal flap surgery is a useful adjunct surgical modality where persistent VPI has been diagnosed. This is limited to those cases where a bony bridge in the hard palate is present.

Key words: palatal bone distraction; velopharyngeal incompetency

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Palatal bone distraction an option for velopharyngeal incompetency after repeatedly failed velopharyngeal flap surgery
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