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June 1989

Treatment of Patients With Cleft Palate in Consideration of Nasal Breathing and Speech

Arch Otolaryngol Head Neck Surg. 1989;115(6):750. doi:10.1001/archotol.1989.01860300104030

To the Editor.—The soft palate has a functional role in phonation and breathing, and by its strategic location plays the role of a gate in the subtle machinery governing air flow through the nose and/or mouth.1 Both speech and nasal respiration depend on nasal airway, nasopharyngeal cavity, and velopharyngeal orifice cross area. In patients with cleft palate, speech performance and breathing must be studied together.1,2 The patients can be obligatory mouth breathers because of nasal deformities but also because of adenoidal hypertrophy, and adenoidectomy is to be avoided. Another cause can be a narrow cross-sectional area of the velopharyngeal valve in rest, ie, in breathing. This is the price that has to be paid for having a competent velopharyngeal valve in speech. Patients with borderline velopharyngeal deficiency can present significantly impaired speech, and occasionally speech in patients who demonstrate gross velopharyngeal incompetence is significantly better than could