The modified Honig velopharyngoplasty – a new technique to treat hypernasality by palatal lenghtening

SummaryBackgroundPalatal lengthening by pushback with a pharyngeal flap is a commonly used operative technique for the treatment of velopharyngeal insufficiency. The conventional Honig velopharyngoplasty uses full thickness mucoperiosteal flaps for the oral lining of the defect.PurposeA modification is described using only mucosal flaps, thus preserving the periosteum and the palatine arteries. Vascularisation of the hard palate is preserved and bone is not exposed, avoiding potential detrimental scar formation overlying the hard palate, which may affect normal outgrowth of the maxilla.Study designEight patients with persisting hypernasality were included. Velopharyngeal closure was evaluated by nasendoscopy, nasometry and a Dutch speech test for cleft patients.ResultsHypernasality was corrected in all cases. One patient developed a light hyponasality. In four patients the overall speech normalised and in the remaining four cases small errors persisted, but speech was well understandable.ConclusionThe procedure yields satisfactory speech results in this preliminary study, comparable to the conventional Honig velopharyngeaplasty. Long term follow up regarding maxillary growth and comparative studies with other operative techniques are now warranted.