The operative treatment of cleft palate

Abstract

T HE indistinctness of speech associated with a cIeft paIate too often persists after the cIeft has been cIosed by operation. The reason for this is that the repaired palate is stiI1 unabIe to shut off the nasa1 cavity from the mouth. Perfect speech is possibIe onIy when the voice sound can be projected forward into the mouth at wiI1, and any operation, besides cIosing the cIeft in the paIate, shouId be designed to overcome, as much as possibIe, the factors that are known to prevent the cIosing of the aperture between the mouth and the nose. With a norma paIate, the mouth communicates with the nasa1 cavity by way of an aperture that is considerabIy wider from side to side than from before backwards. This aperture can be closed at wiI1 by muscIe action. The muscIes concerned are not arranged in a ring, as most sphincters are, but are arranged in two shngs, an anterior and a posterior. The posterior sIing is formed by a part of the superior constrictor of the pharynx opposite the anterior arch of the atlas. When this contracts, a transverse ridge is made prominent on the posterior waI1 of the pharynx, Passavant’s cushion. The anterior sIing is formed mainIy by the Ievator muscIes of the paIate which run downward and forward and are inserted into about the middIe of the palataI aponeurosis immediateIy to either side of the midIine. In taIking, Passavant’s ridge is heId constantIy prominent, and cIosure of the aperture is brought about, when needed, by the Ievator muscIes puhing the part of the paIate to which they are attached upward and backward into contact with this ridge. CompIete cIosure is possibIe, with a norma paIate, because the part into which the Ievator muscIes are inserted is situated opposite Passavant’s ridge and the paIate is Ioose and AexibIe ONTARIO