Speech Resonance after Section of Pharyngeal Flap: Case Report

Introduction: Pharyngeal flap surgery is a procedure for correcting speech symptoms of velopharyngeal insufficiency. Despite high rate of success in eliminating speech symptoms, the flap can lead to upper airway impairment, due to the nasopharynx obstruction and to the small size of the lateral ports, those are insufficient to maintain nasal breathing at rest. In such cases, it is necessary a surgical section of the flap.

Objective: To describe a case submitted to complete section of the pharyngeal flap, based on the respiratory symptoms analysis, perceptual speech resonance, and nasopharyngeal cross-sectional area measurement by means of pressure-flow technique, before and after surgery.

Report: Thirteen years male patient, with repaired cleft palate and pharyngeal flap, with nasal obstruction, mouth breathing and snoring, normal speech resonance, and subnormal values of nasopharyngeal area (0.315 cm²). Based on these results, flap surgical section was recommended to eliminate respiratory disorders despite the risk of speech resonance deterioration. After surgery, respiratory complaints ceased and nasopharyngeal area increased reaching normal values (1.067 cm²). It was also found that speech resonance remained normal, which was an unexpected outcome.

Conclusion: Results showed that the complete pharyngeal flap section can led to improvement of the upper airway patency by increasing nasopharyngeal dimensions without, however, leading to the occurrence of speech nasality. Velopharyngeal closure, even in the absence of the pharyngeal flap, can be explained by the adequate performance of velopharyngeal structures, as a persistent pattern learned from the pharyngeal flap.

Keywords: Pharyngeal flap, respiratory disorders, nasality, nasopharyngeal dimensions.