eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Postpalatoplasty Speech Dysfunction: Multimedia

Author: Peter D Witt, MD, Associate Clinical Professor, Department of Surgery and Pediatrics, University of California San Francisco; Medical Director, Department of Pediatric Plastic Surgery, Children's Hospital Central California
Contributor Information and Disclosures

Updated: Aug 26, 2008

Multimedia

Schematic lateral view of the velopharynx illustr...
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Media file 1: Schematic lateral view of the velopharynx illustrating anatomy.
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Schematic lateral view of the velopharynx illustr...

Schematic lateral view of the velopharynx illustrating anatomy.

Schematic bird's-eye view of the velopharynx illu...
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Media file 2: Schematic bird's-eye view of the velopharynx illustrating directional movements of the representative closure patterns.
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Schematic bird's-eye view of the velopharynx illu...

Schematic bird's-eye view of the velopharynx illustrating directional movements of the representative closure patterns.

Palatal lift. Hard and soft palatal components ar...
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Media file 3: Palatal lift. Hard and soft palatal components are shown.
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Palatal lift. Hard and soft palatal components ar...

Palatal lift. Hard and soft palatal components are shown.

Palatal lift in situ.
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Media file 4: Palatal lift in situ.
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Palatal lift in situ.

Palatal lift in situ.

Preoperative nasoendoscopic view of the velophary...
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Media file 5: Preoperative nasoendoscopic view of the velopharynx. One and 2 are the lateral pharyngeal wall, 3 is the velum, and 4 is a tonsil.
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Preoperative nasoendoscopic view of the velophary...

Preoperative nasoendoscopic view of the velopharynx. One and 2 are the lateral pharyngeal wall, 3 is the velum, and 4 is a tonsil.

Postoperative nasoendoscopic view of the velophar...
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Media file 6: Postoperative nasoendoscopic view of the velopharynx, indicating an open pharyngeal flap as a central subtotal midline obstruction; 2 patent velopharyngeal ports are visible laterally.
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Postoperative nasoendoscopic view of the velophar...

Postoperative nasoendoscopic view of the velopharynx, indicating an open pharyngeal flap as a central subtotal midline obstruction; 2 patent velopharyngeal ports are visible laterally.

Postoperative nasoendoscopic view of the velophar...
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Media file 7: Postoperative nasoendoscopic view of the velopharynx, indicating 2 lateral pharyngeal walls opposed against a pharyngeal flap to effect complete velopharyngeal closure.
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Postoperative nasoendoscopic view of the velophar...

Postoperative nasoendoscopic view of the velopharynx, indicating 2 lateral pharyngeal walls opposed against a pharyngeal flap to effect complete velopharyngeal closure.

Sutures are placed bilaterally in the soft palate...
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Media file 8: Sutures are placed bilaterally in the soft palate to enhance visualization. A midline incision divides the soft palate to the posterior nasal spine.
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Sutures are placed bilaterally in the soft palate...

Sutures are placed bilaterally in the soft palate to enhance visualization. A midline incision divides the soft palate to the posterior nasal spine.

Soft palate flaps are retracted.
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Media file 9: Soft palate flaps are retracted.
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Soft palate flaps are retracted.

Soft palate flaps are retracted.

An incision is made along the dotted line on the ...
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Media file 10: An incision is made along the dotted line on the posterior pharyngeal wall down to the prevertebral fascia. A pharyngeal flap is created. A "book flap" incision that will line the lateral ports with mucous membrane is then made bilaterally on the nasal surface of the soft palate.
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An incision is made along the dotted line on the ...

An incision is made along the dotted line on the posterior pharyngeal wall down to the prevertebral fascia. A pharyngeal flap is created. A "book flap" incision that will line the lateral ports with mucous membrane is then made bilaterally on the nasal surface of the soft palate.

The pharyngeal flap is plotted with indelible ink...
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Media file 11: The pharyngeal flap is plotted with indelible ink and elevated to the prevertebral fascia. Two soft palate flaps are opened laterally.
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The pharyngeal flap is plotted with indelible ink...

The pharyngeal flap is plotted with indelible ink and elevated to the prevertebral fascia. Two soft palate flaps are opened laterally.

The free inferior edge of the pharyngeal flap is ...
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Media file 12: The free inferior edge of the pharyngeal flap is sutured to the posterior edge soft palate.
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The free inferior edge of the pharyngeal flap is ...

The free inferior edge of the pharyngeal flap is sutured to the posterior edge soft palate.

Sutures are placed between the pharyngeal flap an...
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Media file 13: Sutures are placed between the pharyngeal flap and the nasal edges of the soft palate. The raw surfaces arising from the origin of the pharyngeal flap are closed by simple approximation of tissue.
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Sutures are placed between the pharyngeal flap an...

Sutures are placed between the pharyngeal flap and the nasal edges of the soft palate. The raw surfaces arising from the origin of the pharyngeal flap are closed by simple approximation of tissue.

Two flaps from the soft palate used to cover the ...
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Media file 14: Two flaps from the soft palate used to cover the raw tissue of the pharyngeal flap are sutured to the base of the pharyngeal flap.
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Two flaps from the soft palate used to cover the ...

Two flaps from the soft palate used to cover the raw tissue of the pharyngeal flap are sutured to the base of the pharyngeal flap.

The oral side of the soft palate is sealed to con...
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Media file 15: The oral side of the soft palate is sealed to conceal the pharyngeal flap.
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The oral side of the soft palate is sealed to con...

The oral side of the soft palate is sealed to conceal the pharyngeal flap.

Immediate postoperative view from the oral cavity.
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Media file 16: Immediate postoperative view from the oral cavity.
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Immediate postoperative view from the oral cavity.

Immediate postoperative view from the oral cavity.

Schematic of lateral view. A catheter has been pa...
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Media file 17: Schematic of lateral view. A catheter has been passed transnasally and attached to the uvula.
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Schematic of lateral view. A catheter has been pa...

Schematic of lateral view. A catheter has been passed transnasally and attached to the uvula.

Schematic showing proposed incisions (dashed line...
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Media file 18: Schematic showing proposed incisions (dashed lines).
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Schematic showing proposed incisions (dashed line...

Schematic showing proposed incisions (dashed lines).

Schematic showing elevation of both tonsillar pil...
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Media file 19: Schematic showing elevation of both tonsillar pillar flaps.
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Schematic showing elevation of both tonsillar pil...

Schematic showing elevation of both tonsillar pillar flaps.

Schematic showing rotation of palatopharyngeal fl...
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Media file 20: Schematic showing rotation of palatopharyngeal flaps through 90°. It is ready for attachment to the posterior pharyngeal wall.
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Schematic showing rotation of palatopharyngeal fl...

Schematic showing rotation of palatopharyngeal flaps through 90°. It is ready for attachment to the posterior pharyngeal wall.

Schematic showing a completed sphincter pharyngop...
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Media file 21: Schematic showing a completed sphincter pharyngoplasty. Flaps are overlapped and are sutured to each other and the posterior pharyngeal wall.
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Schematic showing a completed sphincter pharyngop...

Schematic showing a completed sphincter pharyngoplasty. Flaps are overlapped and are sutured to each other and the posterior pharyngeal wall.

Complete nasopharyngeal stenosis.
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Media file 22: Complete nasopharyngeal stenosis.
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Complete nasopharyngeal stenosis.

Complete nasopharyngeal stenosis.

More on Craniofacial, Postpalatoplasty Speech Dysfunction

References
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References

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Further Reading

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Keywords

nasalance, airflow, nasal rustle, nasal turbulence, abnormal cavity coupling, acoustic energy, nasal resonance, grimace, hyponasality, airway evaluation, sphincter pharyngoplasty, postpalatoplasty speech dysfunction, VPD, velopharyngeal dysfunction, speech dysfunction, pharyngeal flap, sphincter pharyngoplasty, speech impediment, speech therapy, language therapy, mouth prosthesis, speech prosthesis, speech bulb, speech obturator, palatal lift, hypernasality, nasal emission, facial grimacing

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Contributor Information and Disclosures

Author

Peter D Witt, MD, Associate Clinical Professor, Department of Surgery and Pediatrics, University of California San Francisco; Medical Director, Department of Pediatric Plastic Surgery, Children's Hospital Central California
Peter D Witt, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Hand Surgery, American Association of Pediatric Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Plastic Surgeons, and Plastic Surgery Research Council
Disclosure: Nothing to disclose.

Medical Editor

Larry Hollier, Jr, MD, Assistant Professor, Department of Plastic Surgery, Baylor University College of Medicine
Larry Hollier, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, AO Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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