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


ePlasty. 2013;13 

In This Article


Since the fascial lata was ringed without tension caused by squeezing, no dead spaces were left following surgery and no accumulation of blood or exudate was observed. Obstructive sleep apnea did not occur despite the presence of postoperative swelling and slight augmentation of the pharynx by the fascia lata graft.

Postoperative pharyngoscopic findings showed narrowing of the pharyngeal port at rest and complete closure of the port during phonation and speech (Figs 1c and 1d).

Videofluoroscopy also showed sufficient elevation of the soft palate at rest, which reduced the amount of palatal movement necessary to completely close the pharyngeal port. Her velopharyngeal distance improved to 7 mm in a resting state and showed complete closure of the pharyngeal port during phonation and speech (Figs 2d-2f).

Regarding perceptual speech analysis by pathologists, the patient's phonation was noted to have greatly improved and her speech had normalized. In particular, her glottal stop articulation disorder had disappeared except for /k/ phonation, which was probably due to mislearning.

Hypernasality had worsened at 1 month postoperatively, likely from swelling, but slowly reduced to a normal range with gradual postoperative shrinkage of the ringed fascia lata graft. Hyponasality did not worsen after surgery. The time-series data of her nasalance scores confirmed improvement ( Table 1 ).