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Velopharyngeal Incompetency

Velopharyngeal incompetency and its repair - The ULTIMATE Clinical pearls To achieve the ultimate result various aspects have to be considered. Ignoring one or more of these aspects will lead to suboptimal functional results in velopharyngeal incompetency repair. 1. The velopharyngeal repair is indicated in children at 4 to 4½ years of age, if intensive speech therapy does not lead to sufficient improvement and anatomical velopharyngeal sphincter competence. 2. The wider the initial defect of the sP cleft and the shorter the repaired soft palate, the higher the incidence of velopharyngeal incompetence . 3. The shorter the repaired soft palate and the less adenoid gland tissue, the higher the incidence of velopharyngeal incompetence. Therefore, adenoid gland tissue should never be removed or trimmed. Tonsillectomy, however, can be performed in cases where adequate muscular repair was done during the primary soft palate repair. 4. A velopharyngeal flap should never ever be inferiorly pedicled, as it will limit the normal superior lifting of the soft palate. 5. Dynamic sphincter plasty should not be used as the 1st choice, however, as an adjunct surgical procedure to achieve sufficient closure, with incomplete closure after a velopharyngeal flap procedure or for a very fibrotic soft palate. Bilateral flaps may be created from the tonsillar pillars. If this tissue is not available, then from the oropharyngeal wall. 6. Palatal distraction osteogenesis in antero-posterior direction should only be performed after 2/3 facial skeleton growth has been completed, at around 9 years of age. Furthermore it should only be used in non-hP cleft cases or in cases which have up to 30% hP cleft deformity. 231

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Cleft Ultimate Treatment  

Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...

Cleft Ultimate Treatment  

Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...

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