Size of Velopharyngeal Structures After Primary Palatoplasty

Objective: To describe and compare measures of velar length, velar thickness, and depth of the nasopharynx between two groups of patients with velopharyngeal dysfunction after primary palatoplasty: one received the modified Langenbeck procedure and the other the Furlow procedure.

Design: Comparative study involving a convenience sample of videofluoroscopic films established prospectively.

Setting: Surgeries and videofluoroscopic assessments were conducted at a craniofacial center.

Participants: Exams from 90 participants were used: 27 (30%) operated with Furlow and 63 (70%) with Langenbeck. Three speech-language pathologists (SLPs) traced the images of the velopharyngeal port to determine the measures of interest.

Results: Intrajudge agreement for the SLPs ranged between 0.85 and 0.53, while interjudge agreement ranged between 0.44 and 0.51. The overall measure of velar length was significantly larger (P = .042) for the Furlow group (mean = 26.5) than the Langenbeck group (mean = 24.2 mm). There was no significant difference in velar thickness or depth of the nasopharynx between the two procedures. Although no significant difference was found between the current findings and Subtelny's norms for length, thickness, and depth, the patients presented with an overall depth:length ratio (0.89) significantly greater than Subtelny' ratio (P = .025).

Conclusion: The findings of this study confirmed the hypothesis that patients who underwent surgery with the Furlow technique may present with significantly longer velums than patients who underwent surgery with the Langenbeck procedure. Information regarding velopharyngeal morphology was predictive of velopharyngeal dysfunction for speech for 80% of the participants and can be useful in documenting outcome of treatment.