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January 1967

Treatment of Velopharyngeal Incompetence

Author Affiliations

From the Department of Otolaryngology and Maxillofacial Surgery, University Hospitals, University of Iowa, Iowa City.

Arch Otolaryngol. 1967;85(1):67-74. doi:10.1001/archotol.1967.00760040069013

THE OBJECTIVE of cleft palate repair is, of course, not only to correct the embryonic defect but also to establish normal speech. For the sizeable percentage of patients in whom this objective fails, various operative procedures were designed during the past century to correct the residual velopharyngeal incompetence. The approach to the problem was based on one of three objectives (Fig 1): To increase the length of the palate; to create a pad on the posterior nasopharyngeal wall; or to create a barrier between the oropharynx and the nasal cavity.

Historical Background  The first correct insight into the physiology of the soft palate was published in 1805 by Sandifort.1 Passavant,2 in 1862, was thus able to recognize that, after successful closure of the cleft palate, the nasal intonation of the voice was due to the inability of the soft palate to reach the posterior pharyngeal wall.As the

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