Comparison of submucous cleft palate and congenital velopharyngeal incompetence.
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The differential diagnosis between submucous cleft palate and congenital velopharyngeal incompetence is occasionally rather difficult, because the criteria have not yet been clearly defined.If the median part of the soft palate is obviously membranous and thin on inspection or palpation, it can be diagnosed as submucous cleft palate (SMCP). In patients with congenital hypernasality without this sign, the diagnosis is congenital velopharyngeal incompetence (CVPI).Velopharyngeal function in SMCP and CVPI was assessed mainly by fluorovideoscopy and nasoendoscopy, which sometimes show a deep pharynx, short palate, or occult submucous cleft palate. The term CVPI usually includes short palate, occult submucous cleft palate, deep pharynx, and large pharynx other than submucous cleft palate.Selection of the surgical method to be used was based on analyses of these results with the age factor taken into account.Push-back palatoplasty was performed on these patients who were diagnosed as having slight velopharyngeal incompetence in spite of good mobility of the velum and were under 4 years of age.For those with moderate to severe velopharyngeal incompetence, the folded pharyngeal flap is usually indicated to secure velopharyngeal function.Twenty-four of 34 SMCP patients treated surgically acquired adequate velopharyngeal function and normal speech; in two of the 34 patients slight velopharyngeal incompetency persisted, and the remaining 8 patients could not be followed up after surgery.Twenty-four of 30 CVPI patients treated surgically acquired adequate velopharyngeal function, three still had slight velopharyngeal incompetency, and the remaining three are being followed after surgery. Articulation training before and/or after operation is very important. When faulty articulation was corrected before operation, the period for post-operative articulation training was short.Seven out of 66 SMCP patients have acquired normal speech through speech therapy alone.
- 耳鼻咽喉科臨床学会の論文
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