Surgical options include pushback palatoplasty, pharyngoplasty, and palatopharyngoplasty. Pushback palatoplasty is useful in patients with short palates and good lateral pharyngeal wall mobility. Good levator veli palatini function makes pharyngoplasty a viable option in selected patients. Surgical complications include bleeding, infection, airway obstruction, decreased lateral pharyngeal wall motion, and persistent velopharyngeal insufficiency. In summary, velopharyngeal insufficiency is quite common after cleft palate repair.
Early diagnosis is facilitated by videofluoroscopy and nasal endoscopy.
Indirect and semidirect measures have proven of little value in rehabilitating these challenging patients, making surgery the treatment of choice in the majority of affected children. At Texas Children's Hospital the cleft palate team is utilizing digital palatal facilitation with pressure being applied to the posterior muscular palate, compressing this flaccid structure posterosuperiorly until contact is made to the posterior pharyngeal wall. Favorable preliminary results have prompted a prospective study to evaluate the efficacy of this previously undescribed treatment option. At two months of age he underwent tracheotomy and gastric feeding tube placement. He was referred to the Texas Children's Plastic Surgery Service at nine months of age and was managed by the cleft palate team.