A patient with velopharyngeal insufficiency presents to Dr SM Balaji

The patient had been born with a cleft lip and palate. This had been set right as an infant. She later developed velopharyngeal incompetence. This is where there is escape of air through the nose during speech. It also manifested as difficulty pronouncing certain words well. This also added a nasal twang to her voice. She searched far and wide for the right cleft lip and palate surgeon to correct her problem. The patient was then referred to Dr SM Balaji. He is a world renowned cleft lip and palate surgeon.

Surgery planned for the patient

Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined her. He explained to her that she needed a pharyngoplasty surgery to correct this. The patient was in agreement with this and was then scheduled for surgery. Aim of this surgery is to create a dynamic sphincter in the pharynx. Repositioning of the palatopharyngeus muscles achieves this.

The surgical procedure

The patient was then taken to the operating room. She then underwent general anesthesia without complications. Incisions were then made to release the posterior faucial pillars. This included the palatopharyngeus muscles. These muscles were then crisscrossed and sutured together on the posterior pharyngeal wall. A sphincter was thus formed here. This left a small opening or “port” for breathing through the nose.

Successful positive suction test

A positive suction test was then performed after completion of the surgery. This demonstrated a new dynamic velopharyngeal sphincter action. Correction of the patient’s velopharyngeal incompetence was thus completed.

The patient expressed total satisfaction with the results of the surgery. She was then discharged from the hospital.