Lateral defects in velopharyngeal insufficiency. Diagnosis and treatment.

A variety of surgical techniques is available for the closure of substantial velopharyngeal defects. While the use of the centrally based pharyngeal flap remains the cornerstone of surgical treatment, there are patients who have poor lateral pharyngeal wall (LPW) mobility. After surgery that uses a centrally based flap, the speech result in such patients is less than optimal, since the poorly mobile LPW does not approximate to the central flap, thus creating a lateral defect. We have added the Towne view to our protocol for cine-speech studies to study better the lateral defects. This view is perpendicular to the velopharyngeal spincter and shows the true-purse-string nature of it. The incidence of such defects in our last 40 consecutive patients is reviewed. Based on the existence of a lateral defect, recommendations are made for a system of operations in the treatment of velopharyngeal insufficiency.