Hemipalatal hypoplasia.

Asymmetric velopharyngeal incompetence (VPI) has a diverse etiology, but those without any underlying cleft, hemifacial microsomia (HFM), or facial asymmetry are rarely encountered. Such cases have been reported within the last few years, with unilateral velopharyngeal hypoplasia identified to be the underlying abnormality in these patients. However, there have been no reports to date on asymmetric VPI from idiopathic hemipalatal hypoplasia. A retrospective review of patients whose conditions were diagnosed with asymmetric VPI owing to hemipalatal hypoplasia and who do not have underlying cleft, HFM, or any significant facial asymmetry was performed. During a 10-year period, 5 patients with asymmetric VPI from idiopathic hemipalatal hypoplasia were treated at our center. Four of 5 of these patients presented with nasal regurgitation. Two were found to have tonsillar enlargement on the side of the hemipalatal hypoplasia, and another had an ipsilateral tongue mass that subsequently required wedge excision. Two were managed conservatively with speech therapy, whereas the other 3 developed speech problems that required surgery. The first patient underwent a skewed pharyngeal flap, but her speech problem improved only after a second surgery, which involved a centralized pharyngeal flap. The speech problems of the last 2 patients were corrected with a centralized pharyngeal flap. Hence, we conclude that patients with asymmetric VPI from idiopathic hemipalatal hypoplasia, compared with those of other etiology, particularly unilateral velopharyngeal hypoplasia, seem to present in a different manner. When surgical intervention is indicated for correction of the speech problem that eventually develops, centralized rather than skewed pharyngeal flap seems to be more reliable.

Comparison of outcomes of velopharyngeal surgery between the inferiorly and superiorly based pharyngeal flaps.

BACKGROUND: Pharyngeal flaps have been widely used for the correction of velopharyngeal incompetence. The aim of this study was to compare the outcomes of velopharyngeal surgery between those who received the superiorly and inferiorly based pharyngeal flaps. METHODS: A retrospective review of medical records of patients with cleft palates who received pharyngeal flap surgery for the correction of velopharyngeal incompetence at one craniofacial center was performed. The superiorly based flaps were elevated and inset using the fish-mouth method. The inferiorly based flaps were sutured to the soft palate where a distally based mucosa flap was turned over to cover the raw surface of the flap pedicle. The velopharyngeal functions were categorized as adequate, marginal, or inadequate. Complications associated with the operation were documented. Statistical comparisons between the two groups were made. RESULTS: There were 65 patients in each group. No statistically significant differences were found for sex distribution and age at operation. The outcomes of the velopharyngeal surgery were better in the group of patients who received the inferiorly based pharyngeal flaps (p = 0.030). The complications were not significantly different between the two groups, and were all relatively mild. CONCLUSION: The inferiorly based pharyngeal flap was more effective than the superiorly based pharyngeal flap for the correction of velopharyngeal incompetence. A probable explanation may be the fibrotic changes and scar contracture occurring in the pedicle of the superiorly based pharyngeal flap that may have impaired the velopharyngeal closure.