Congeital Velopharyngeal Insufficiency Without Cleft Palate and Submucous Cleft Palate

I compared the 53 patients with congenital velopharyngeal insufficiency without cleft palate with the 29 patients with submucous cleft palate.Velopharyngeall insufficiency without cleft palate (53 patients):1) They were divided into two groups according to the characteristic shapes of their palates, that was non-cleft palate and pseudo cleft palate. In the non-cleft palate patient, the palate showed normal or broad uvula, normal looking soft palate, and flat edge of the hard palate. On the other hand, in the pseudo cleft palate patient, the palate showed bifid uvula, thin muscular layer on median raphe, and a slight notch in the hard palate.2) In their history, birth asphyxia was found in 27 patients, congenital heart disease in 13 patients, convulsive seijure in ten, chronic otitis media in seven, and speech retardation in 48 patients.3) Twenty-eight patients looked alike, and they were divided into two groups according to their characteristic facial signs, the humorous type and the nervous type.4) Muscular atrophy of the soft palate was proved on pathological examination.5) In a total of fifty patients repair was ultimately achieved by pharyngeal flap operation. It was concluded that the push-back operation was an ineffectual procedure in reducing velopharyngeal insufficiency, whereas the pharyngeal flap operation was an effective treatment.6) There was a marked post-operative improvement in speech in 39 patients, fair improvement in 11 patients, no improvement in 3 patients.Submucous cleft palate (29 patients):1) The palate shows a bifid uvula, no muscular layer on median raphe, and a large defect in the hard palate.2) In their history, asphyxia was found in 4 patients, speech retardation in 10 patients. Neither congenital heart disease nor convulsive seijure were found in any patients.3) There was no facial resemblance.4) Muscular atroply of the soft palate was not proved in these patients.5) The push-back operation was effective in 17 patients.6) There was a marked post-operative improvement in speech in 27 patients and fair improvement in two patients.