Reconstruction of a total soft palatal defect using a folded radial forearm free flap and palmaris longus tendon sling.

Abstract

BACKGROUND:

The soft palate functions as a valve and helps generate the oral pressure required for normal speech resonance. Speech problems and nasal regurgitation can result from a soft palatal defect. Reduction of the size of the velopharyngeal orifice is required to compensate for the lack of mobility in a reconstructed soft palate. We suggest a large volume folded free flap for reduction of the caliber and a palmaris longus tendon sling for suspension of the reconstructed palate.

METHODS:

Six patients had total soft palate resection for tonsillar cancer and reconstruction with a large volume folded radial forearm free flap combined with a palmaris longus sling. A single surgeon and speech therapist examined the patients with three standardized speech assessment tools: nasometer test, consonant articulation test, and speech acuity test performed for speech evaluation.

RESULTS:

Mean nasalance score was 76.20% for sentences with nasal sounds and 43.60% for sentences with oral sounds. Hypernasality was seen for oral sound sentences. The mean score of the picture consonant articulation test was 84% (range, 63% to 100%). The mean score of the speech acuity test was 5.84 (range, 5 to 6). These mean ratings represent a satisfactory level of speech function.

CONCLUSIONS:

The large volume folded free flap with a palmaris longus tendon sling for total soft palate reconstruction resulted in satisfactory prognosis for speech despite moderate hypernasality.

• Authors: Myung Chul Lee, Dong Won Lee, Dong Kyun Rah, Won Jai Lee
• Journal: Archives of plastic surgery (Arch Plast Surg) Vol. 39 Issue 1 Pg. 25-30 (Jan 2012) ISSN: 2234-6171 [Electronic] Korea (South)
• PMID: 22783487 (Publication Type: Journal Article)