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http://dx.doi.org/10.5999/aps.2012.39.1.25

Reconstruction of a Total Soft Palatal Defect Using a Folded Radial Forearm Free Flap and Palmaris Longus Tendon Sling  

Lee, Myung-Chul (Department of Plastic and Reconstructive Surgery, Yonsei University Severance Medical Center, Yonsei University College of Medicine)
Lee, Dong-Won (Department of Plastic and Reconstructive Surgery, Yonsei University Severance Medical Center, Yonsei University College of Medicine)
Rah, Dong-Kyun (Department of Plastic and Reconstructive Surgery, Yonsei University Severance Medical Center, Yonsei University College of Medicine)
Lee, Won-Jai (Department of Plastic and Reconstructive Surgery, Yonsei University Severance Medical Center, Yonsei University College of Medicine)
Publication Information
Archives of Plastic Surgery / v.39, no.1, 2012 , pp. 25-30 More about this Journal
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.
Keywords
Palate, soft; Free tissue flaps; Speech;
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