Transverse pharyngeal flaps: a dynamic repair for velopharyngeal insufficiency.

During the past three years, forty-eight patients, ranging from five to thirty years of age, have undergone bilateral transverse pharyngeal pedicles to the palate. Thirty-nine patients had not had pharyngeal flaps prior to this procedure and the remaining nine patients had failure of production of acceptable speech after undergoing inferiorly or superiorly based flap operations. One patient suffered separation of the suture line. Dramatic improvement in speech has been noted in the remaining forty-seven patients. While it is difficult to compare the speech results to other procedures, a significant finding has been achievement of satisfactory speech in all nine patients referred for correction after failure with superiorly or inferiorly based flaps. Muscle survival, as evidenced by consistent electromyograph studies, demonstrated functioning double pharyngeal sphincters to control airway shunting during rapid spontaneous speech. The use of transverse pharyngeal flaps offers an obturator effect and the added benefit of active muscle for airstream control in speech function to correct nasality in cleft palate patients. Preservation of the integrity of the neuromuscular component of these pedicles assures survival of the tissue mass for its obturator effect. A modified procedure has been adapted for patients with failure of production of acceptable speech, after using inferiorly or superiorly based flaps.