Abstract
Pharyngeal flap operation has been used widely for repair of velophayngeal incompetency. We have advocated "Palatal Pull Upward Method" in unilateral and bilateral cleft palate repair. The purpose of this palatal pull upward method is to shorten the vertical distance of the velopharyngeal space at rest position. Thus, this operation functionally coincides with the direction of the levator muscle constriction. We applied this cocept to velopharyngeal insufficiency.
operation method
1) Both palatal mucoperiosteal flaps are sufficiently freed to reach the posterior pharyngeal wall.
2) A vertical incision is made from just below the adenoid mass at the level of the atlas on the posterior pharyngeal wall.
3) The incision is deepend to the whitish prevertebral fascia and only the left side is elevated.
4) The right nasal mucosal flap is guided into the left posterior pharyngeal wall pocket and attached with mattress sutures.
5) After the left nasal mucosa is sutured to the opposite nasal mucusa, the levator muscles on each side are sutured together to construct a muscle sling.
Lateral X-ray film and nasopharyn geal fiberscopic findings show satisfactory results. We have used this method and had good speech results in all 20 cases. Compared with conventional operations, this method is very simple and the direction of the levator muscle movement coincides with the position of orifice when the velum is pulled upward.
