THE ULTIMATE aim of surgery of the cleft palate is not only to close the defect but to establish normal speech. In the latter objective surgical repair frequently fails, even after adequate periods of speech therapy. In many cases this is due to the anterior pull of the contracting raw surfaces on the nasal side of the mucoperiosteal flap, which results in a "short palate." When healing has occurred, the contracted scar tissue prevents the velum from closing the velopharyngeal sphincter, and so the patient's speech remains defective.
Many ingenious methods have been devised to overcome this fault in the von Langenbeck operation. Advancement of the pharyngeal wall has been advocated and has been effected by such methods as vertical suturing of a transverse incision,1 formation of pharyngeal flaps,2 injection of paraffin3 and insertion of cartilage, but in general these procedures either do not remain effective or
BAXTER H, DRUMMOND J, ENTIN M. USE OF SKIN GRAFTS IN REPAIR OF CLEFT PALATE TO IMPROVE SPEECH. Arch Surg. 1949;59(4):870-881. doi:10.1001/archsurg.1949.01240040879007