Levatorplasty, a new technique to treat hypernasality: anatomical investigations and preliminary clinical results

Background: Velopharyngoplasty is the most commonly used operative technique for the treatment of velopharyngeal insufficiency. By attaching a posterior pharyngeal flap to the velum, a nonphysiological situation is created in the upper airway. Purpose: The aim of this investigation was to find a new surgical approach to physiological reconstruction of the velopharyngeal sphincter. Material: Anatomical investigations were performed in four cadavers. From this study a new surgical technique was developed and called ‘levatorplasty’: the musculus longus capitis was taken to create a new muscular loop leading to (a) an augmentation of the posterior wall, (b) a medial shift of the lateral pharyngeal wall; and (c) stretching of the velum posteriorly. Thus, the velopharyngeal space was reduced and a physiological closure of the nasal airway space could be obtained. Study design: The levatorplasty was employed in nine cleft palate patients with velopharyngeal insufficiency. Pre- and postoperatively the velopharyngeal closure was evaluated by phonetic and radiological examination. Results: The operation was easily performed without major complications. A concentric constriction with decrease of the velopharyngeal space was achieved and a definitive decrease of nasalance and hypernasality resulted. Conclusion: Long-term follow-ups have to verify whether these results will be stable. They also have to be compared with functional improvements following velopharyngoplasty or pharyngoplasty. Of special interest will be evaluation of the altered mobility of the lateral pharyngeal walls.