Velopharyngeal Flap Procedure

Velopharyngeal insufficiency may cause symptoms such as abnormal nasal resonance and compensatory articulation errors, which can ultimately impact an individual’s speech intelligibility (Keunig, Wieneke, & Dejonckere, 1999). The pharyngeal flap procedure is one method for improving velopharyngeal closure. A retrospective study by Liedman-Boshko, Lohmander, Persson, Lith, and Elander (2005) examined whether pharyngeal flap surgery led to improved speech outcome measures and increased lateral pharyngeal wall movement in 28 children (ages 5:5 to 14:3 years) with cleft palates and velopharyngeal insufficiency. All participants underwent a pharyngeal flap procedure between 1990 and 1997 and received videofluoroscopy pre- and post-surgery. Two trained speech-language pathologists (SLPs) blindly rated the participants’ speech using a perceptual rating scale. Speech variables included (but were not limited to) hypernasality, weak pressure consonants, glottal articulation, and additional compensatory articulation errors. Lateral pharyngeal wall movement was also assessed using a perceptual rating scale ranging from “no movement” to “complete midline closure” (Liedman-Boshko et al., 2005).
Improvements in these two variables were positively correlated with time post-surgery. A significant improvement in glottal articulation was also indicated. It is important to note that these improvements may have been influenced by postoperative speech therapy. Further, the three participants who demonstrated little to no improvements in glottal articulation were diagnosed with additional anomalies or syndromes (anomalies and syndromes not specified). Finally, the participants with greater lateral pharyngeal wall movement pre-operation demonstrated the most improvements in hypernasality and weak pressure consonants post-operation (Liedman-Boshko et al.,