Distraction of the hard palate for treating velopharyngeal incompetence. A case report.

A multitude of procedures exist for treating velopharyngeal incompetence. Because of the morphological variety of problems, several of the currently available procedures can be justified. Each method is associated with its own specific problems and risks, and therapeutic success is often unsatisfactory in a manner which depends on the genesis and extent of the anomaly. The presented case showes a new procedure for treating velopharyngeal incompetence. In a seven year old boy with extensive rhinophonia aperta after an operative cleft palate closure, the dorsal edge of the hard palate and the pterygoid process were osteotomized, and a distraction device was fitted. After a latent period of one week distraction was performed for ten days at 0.75 mm per day. In ten days it was possible to achieve a dorsal displacement of the osteotomized complex amounting to 7.5 mm. Operation, distraction, and the postoperative period proceeded without any problems. The distance between the soft palate and the posterior pharyngeal wall was decreased by approximately 7 mm while the mobility of the soft palate musculature was maintained. Three months after the operation, both rhinophonia aperta and speech comprehensibility were markedly improved. First experiences with the distraction of the palate for treating velopharyngeal incompe-tence were positive. Experiments need to be performed on other patients and over a longer observation period in order to perform a reliable evaluation of this procedure. Keywords: distraction osteogenesis, cleft lip palate, intraoral distraktion device, velopharyngeal incompetence