A Ringed Fascia Lata Graft Without Peritendinous Areolar Tissue Encircling the Levator Veli Palatini and Superior Pharyngeal Constrictor Muscles Gradually Shrinks to Reduce Velopharyngeal Incompetence, Functioning as an Intravelar Palatal Lift

Kenya Fujita, MD, PhD; Kiyoshi Matsuo, MD, PhD; Shunsuke Yuzuriha, MD, PhD

Disclosures

ePlasty. 2013;13 

In This Article

Abstract and Introduction

Abstract

Introduction: We have previously reported that fascia lata grafts with peritendinous areolar tissue used to treat severe congenital blepharoptosis gradually shrink within 6 weeks postoperatively and maintain long-term shrinkage of 15.5% on average. Accordingly, it seemed possible that a fascia lata graft without peritendinous areolar tissue would shrink more than the one with peritendinous areolar tissue in a clinical setting. We evaluated this possibility in a patient with Klippel-Feil syndrome having postoperative deep atonic nasopharynx.

Methods: In combination with intravelar veloplasty and palatal lengthening with modified bilateral buccinator sandwich pushback, a ringed fascia lata without peritendinous areolar tissue encircling the levator veli palatini and superior constrictor muscles was grafted to cure severe velopharyngeal incompetence.

Results: Obstructive sleep apnea did not occur following surgery. Pharyngoscopy, videofluoroscopy, and nasometry showed no amelioration of velopharyngeal incompetence at 1 month postoperatively, but marked velopharyngeal incompetence reduction was evident at 4 months and 2 years after surgery.

Conclusions: The extended recovery period suggests that the anticipated postoperative shrinkage of the ringed fascia lata without peritendinous areolar tissue played a more prominent role than intravelar veloplasty and palatal lengthening, which posteroinferiorly elongated the atonic soft palate. Although the pharyngeal flap procedure is the most popular technique for treatment of velopharyngeal incompetence, it is sometimes accompanied by respiratory complications. Thus, the gradual postoperative shrinkage of a ringed fascia lata graft encircling the velopharyngeal muscles functions as an intravelar palatal lift and may be an additional surgical method with less respiratory complications to narrow atonic nasopharyngeal port.

Introduction

We have previously reported that fascia lata grafts with peritendinous areolar tissue used to treat cases of severe congenital blepharoptosis with frontalis suspension gradually shrink within 6 weeks postoperatively and maintain long-term shrinkage of 15.5% on average.[1] We also reported that anterior tibial tendon grafts with and without peritendinous areolar tissue in rats showed 1-month postoperative shrinkage of 22.9% and 48.6%, respectively, and 5-month postoperative shrinkage of 35.7% and 58.6%, respectively.[2] Since the vascular network of the peritendinous areolar tissue, which may have contributed to early revascularization of the graft, was removed, tendon grafts without peritendinous areolar tissue appeared to decrease survival of the endotendinous tissue and increase postoperative shrinkage. Accordingly, we aimed to clinically evaluate the possibility that a fascia lata graft without peritendinous areolar tissue would gradually shrink more than the one with peritendinous areolar tissue to narrow postoperative deep atonic nasopharyngeal port in a patient with Klippel-Feil syndrome.

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