Teflon pharyngoplasty in incompetent velopharyngeal closure

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Velopharyngeal closure is essential in the production of normal speech. Speech with imperfect closure is characterized by excessive nasal emission of air with concomitant hypernasality and inadequate oral air stream.

Causes of incompetent velopharyngeal closure are cleft palate, congenital short palate, palatal paralysis, and postoperative complications of tonsillectomy and adenoidectomy. Many procedures have been used to correct velopharyngeal insufficiency. Injection of Teflon into the posterior pharyngeal wall, although clinically in the experimental stage, is currently being used in many centers. Teflon was first used for this purpose in 1964 by Lewy et al1 after it had been used successfully to treat vocal cord paralysis. Other substances had been implanted in the posterior pharyngeal wall, such as paraffin, cartilage, bone dust, fat, fascia, silicone, and silicone with a Dacron felt back.2, 3 These materials, however, either produced unpredictable results or caused serious complications. Lewy et al,1 Ward,4 Ward et al,5 and Sturim and Jacob3 have reported excellent results with injection of Teflon.

One of the advantages of this procedure is immediate improvement in speech. The nature of the etiology of velopharyngeal incompetency suggests that most cases should be treated in childhood or shortly after the onset of the insufficiency.

Case report

A 22-year-old man had a lifelong history of hypernasal speech. The diagnosis was not clear-cut at the initial examination. The patient appeared to have ample velar length. Good pharyngeal wall motion and velar action were demonstrable, but there was not adequate closure of the velum in speech. Hypernasal speech was . . .



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