SURGICAL REHABILITATION OF A PATIENT WITH PALATO-PHARYNTERAL INSUFFICIENCY WITH CONGENITAL CLEFT PALATE AFTER URANOPLASTY

Objectives. A clinical case of surgical rehabilitation of a patient with palatopharyngeal insufficiency with congenital cleft palate after uranoplasty. Purpose. Description of the long-term result of surgical treatment of congenital cleft palate, the causes of complications and the rationale for the method of treatment of palatopharyngeal insufficiency. Methodology. The paper presents the results of a clinical observation of a patient aged 12 years with congenital cleft palate after uranoplasty and formed palatopharyngeal insufficiency. A child at the age of 2 years 8 months underwent sparing uranoplasty. Since the child lived in a remote area from the city, he did not have the opportunity to engage in logotherapy. On examination, the soft palate is moderately shortened, postoperative scars are not rough. Speech is vile. To select the most optimal method of treating this pathology, it was necessary to visualize the causes of palato-pharyngeal insufficiency. Results. When conducting an examination using nasopharyngoscopy, a sphincter type of closure of the palatopharyngeal ring was revealed. When pronouncing sounds, the soft palate rose slightly, but the lateral walls of the pharynx with the posterior palatine arches actively contracted, narrowing the palatopharyngeal ring. Taking into account the data obtained during nasopharyngoscopy, a surgical method for eliminating palatopharyngeal insufficiency proposed by M. Orticochea was chosen — “speech-improving surgery”, or sphincter pharyngoplasty, with suturing of the distal ends of the mobilized posterior palatine arches on the posterior pharyngeal wall. According to the control examination for 6 months, there was a significant improvement in speech function, there was no nasalization. Conclusions. Nasopharyngoendoscopy makes it possible to objectively assess the causes of palatopharyngeal insufficiency, which makes it possible to choose the most optimal method of surgical treatment. One of the methods of choice in the surgical treatment of palatopharyngeal insufficiency is the method of sphincter pharyngoplasty.