The self-lined superiorly based pull-through velopharyngoplasty: plastic surgery-speech pathology interaction in the management of velopharyngeal insufficiency.

We present a rationale and step-by-step description of a previously unpublished innovative surgical technique designed to overcome velopharyngeal insufficiency. This procedure maintains the anatomic integrity and physiologic function of the velopharynx by limiting interpalatal dissection and incorporates a method for flap attachment through the velum that is accessible, predictable, and versatile. The efficacy of this procedure in eliminating velopharyngeal insufficiency was evaluated by using rigorously controlled quantitative psychophysical scaling procedures of presurgical and postsurgical perceptual ratings of resonance, nasal emission, and intelligibility and instrumental acoustic analyses. The results indicated significantly better postsurgical speech outcomes by individuals treated with the pull-through velopharyngoplasty than did patients treated with other procedures designed for the secondary management of velopharyngeal insufficiency. Based on our experience with more than 150 patients, we believe that the self-lined superiorly based pull-through velopharyngoplasty represents an advancement in the surgical treatment of velopharyngeal insufficiency.