Naheed Ahmad, Farhan Tariq, Muhammad Ahmed, Saleem A Malik.
Experience of management of velopharyngeal insufficiency at P.I.M.S., Islamabad.
Ann Pak Inst Med Sci Jan ;1(3):154-7.

Adult cleft palate patients present with different problems than those encountered in children and infants. The main concern in adults is the abnormal speech. We designed this study to evaluate the speech outcome in adult cleft palate patients with velopharyngeal insufficiency. Our study was composed of 20 adult patients of cleft palate with a mean age of 18.7 years (range 12 – 30 years). 17 patients presented with unrepaired cleft palates exhibiting markedly deviant speech characteristics. Three surgical techniques were used to treat velopharyngeal insufficiency in our patients. Furlow`s palatoplasty (5 patients), Orticochia pharyngoplasty (4 cases) and superiorly based pharyngeal flap (11 cases). These patients were followed up for an average period of 11 months (range 6 – 26 months). Subjective speech evaluation was done at pre-operative visit and repeated after operation at interval of one and six months. Speech assessment was reported in terms of nasal resonance, nasal air escape, articulation errors and intelligibility of speech. Our results showed that a 91% success rate in terms of normal resonance and nasal air escape in pharyngeal flap group, 80% in Furlow`s group and 75% in Orticochia pharyngoplasty group. We concluded that the pharyngeal flap is an effective treatment for velopharyngeal insufficiency in adult cleft palate patients.

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