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Case Reports
. 2018 Aug 30;40(1):23.
doi: 10.1186/s40902-018-0164-2. eCollection 2018 Dec.

Investigation of postoperative hypernasality after superiorly based posterior pharyngeal flap

Yu-Jeong Shin  1 , Yongsoo Kim  2
Affiliations
Case Reports

Investigation of postoperative hypernasality after superiorly based posterior pharyngeal flap

Yu-Jeong Shin et al. Maxillofac Plast Reconstr Surg. .

Abstract

Background: Velopharyngeal insufficiency that accompanies speech resonance and articulation disorders can be managed through several intervention methods such as speech-language therapy, prosthetic aids, and surgery. However, for patients with severe hypernasality, surgical interventions are highly recommended. Among available surgical techniques, the posterior pharyngeal flap is most common.

Case presentation: Two adult males with high nasalance scores underwent superiorly based posterior pharyngeal flap surgery, followed by speech testing by an expert speech-language therapist. Nasalance scores and articulation accuracy were assessed up until 1 year after the surgery. Nasalance scores were measured five times using a nasometer, after which the average value was calculated.

Conclusions: Consistent declines in hypernasality over time are not easy to explain since the pedicled pharyngeal flap narrowed over time, secondary to cicatrization. However, scar tethering of the soft palate in a posterior direction could reduce the velopharyngeal port size over time. Therefore, long-term follow-up with intensive speech therapy is suggested for patients with severe hypernasality.

Keywords: Cleft palate; Nasalance; Nasometer; Pharyngoplasty; Posterior pharyngeal flap.

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Conflict of interest statement

The practice and the report of cases have been performed in accordance with the Declaration of Helsinki. Ethics approval of report involving less than three cases is waved.Written informed consent was obtained from the patient for publication of this case report and accompanying images.The authors declare that they have no competing interests. All of the authors have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in this manuscript.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Surgical procedure of superiorly based posterior pharyngeal flap and postoperative cicatrization (case 1). a–d Surgical procedure of depicting a typical posterior pharyngeal flap. e, f Postoperative photos while phonating /a/ at 3 months and 6 months post-pharyngoplasty. At 6 months, enhanced posterior movement of the soft palate was found
Fig. 2
Fig. 2
Dimensional change of the pedicle of the posterior pharyngeal flap (case 2). a The pedicle reflected on the dental mirror during the operation. b Three months after the pharyngoplasty. c Six months after the surgery
Fig. 3
Fig. 3
Graph of nasalance score over time. a Nasalance score (%) for five simple vowels and the average value (thick red line) in case 1. b Nasalance score for simple vowels in case 2. c Nasalance score measured during sentence repetition
Fig. 4
Fig. 4
Graph of development on consonant accuracy over time. The assessment was carried out for 43 consonant sounds, and the number of correctly produced consonants was counted to calculate the accuracy (%) as presented in the table below the graph
See this image and copyright information in PMC

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