Primary von Langenbeck palatoplasty with levator reconstruction: rationale and technique.

In the preceding article, patients undergoing von Langenbeck palatoplasty without reconstruction of the levator veli palatini muscles were compared to patients undergoing the identical procedure, but with intravelar veloplasty. Palatoplasty included repair of both hard and soft palate, tension-free approximation of mucoperiosteal and soft palate flaps, and everting suture of nasal mucous membrane and oral mucous membrane from the anterior extent of the palate cleft to the tip of the uvula. No attempt was made to repair an alveolar cleft, if present. The authors concluded that intravelar veloplasty was of significant value in providing velopharyngeal competency, and in this companion article the rationale and technical details are presented.