The results of 100 operations for velopharyngeal incompetence--selected on the findings of endoscopic and radiological examination.

Of one hundred patients with velopharyngeal incompetence subjected to a pharyngoplasty selected on the results of endoscopic and radiological examination 97% were cured of unacceptable nasal escape and 93% of unacceptable nasal resonance on the criteria described. It was considered that this provided a vindication of the system of treatment. Critical examination of the morbidity revealed an unacceptably high proportion of hyponasality. This appeared to be due to ignoring the criteria for selection for pharyngoplasty and opting for the more radical operation resulting in over-treatment in some cases. With the numbers available in the smaller treatment groups it was not possible to state that there was no significant difference in the results between the different pharyngoplasties in the groups for which they were selected. It is expected that there will be a larger proportion of patients receiving less radical treatment without detriment to the success rate, but with a lower morbidity. Assuming that it is accepted that as much accurate information as possible prior to operation is needed for the correct selection of operation, simultaneous endoscopic and radiological examination provide a time- and cost-efficient system the benefit of which becomes overwhelming for revision of the failed pharyngoplasty.