A double palatal pushback operation was designed to correct severe nasopharyngeal insufficiency resulting from conditions such as congenitally short palates, submucous cleft palates, an abnormally deep nasopharynx, and scarred palate following cleft palate closure. Operation 1, employed an Ecker buccal tuberosity incision and a Dorrance palate incision combined with a Cronin nasal flap and nasopharyngeal pushback. This combination of surgical techniques produced a highly flexible and functional lengthening of the soft palate of approximately 1 cm. Operation 2, performed 9 to 12 months later, utilized the same Ecker and Dorrance incisions plus transection of the palatine arteries and a repeat nasopharyngeal pushback, in combination with a superiorly based pharyngeal flap. Two-stage procedures were used in over 35 individual cases of severe velopharyngeal insufficiency with adequate elimination for nasal emission with connected speech.
Smith HW, Hughes M, Rosnagle RS. Double Palatal Pushback: A Technique for Correction of Severe Velopharyngeal Insufficiency. Arch Otolaryngol. 1972;95(1):33–41. doi:https://doi.org/10.1001/archotol.1972.00770080081007
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