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Reconstruction of a total soft palatal defect using a folded radial forearm free flap and palmaris longus tendon sling

 Myung Chul Lee  ;  Dong Won Lee  ;  Dong Kyun Rah  ;  Won Jai Lee 
 Archives of Plastic Surgery, Vol.39(1) : 25-30, 2012 
Journal Title
Archives of Plastic Surgery
Issue Date
Free tissue flaps ; Palate, soft ; Speech
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: Free tissue flaps, Palate, soft, Speech
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1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
Rah, Dong Kyun(나동균)
Lee, Dong Won(이동원) ORCID logo https://orcid.org/0000-0003-0046-3139
Lee, Won Jai(이원재) ORCID logo https://orcid.org/0000-0003-3056-0503
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