Functional soft palate reconstruction: a comprehensive surgical approach.

Background: Dysfunction of the soft palate is devastating to the patient's quality of life, resulting in unintelligible speech and poor swallowing. Reconstruction of the soft palate is complex because the dynamic fibromuscular structure cannot be duplicated. The efficacy of soft palate reconstruction has therefore been called into question. The purpose of this article is: (1) to describe our comprehensive surgical paradigm for soft palate reconstruction, (2) to provide details of the surgical techniques used, and (3) to report on patient functional outcomes.

Methods: Fifty-two patients spanning 3 different size-based categories of soft palate reconstruction were included in the final analysis. Using videofluoroscopic studies of swallowing, the presence of nasopharyngeal reflux and any instance of aspiration of a bolus into the airway was noted. In addition, a simple diet survey was completed, and the use of a g-tube was noted.

Results: The results revealed that our protocol for soft palate reconstruction provided the majority of our patients with separation of the oropharynx and nasopharynx, while maintaining nasal patency. Restoration of swallowing function was timely, with 91% of the patients returning to an oral diet at the early postoperative visit and only 14% of patients demonstrating mild nasopharyngeal reflux.

Conclusion: We have developed a comprehensive reconstructive protocol that provides patients with separation of the oropharynx and nasopharynx, while maintaining nasal patency. Restoration of function is timely, with reestablishment of normal intelligibility and resonance of speech as well as safe and efficient swallowing function.