Underdevelopment of the soft palate: causes, symptoms, diagnosis, treatment

The underdevelopment of the soft palate owes its origin to a disturbance in the development of the embryonic buds of the palatine plates, which can also lead to an anomaly in the development of the hard palate (gothic arch of the oral cavity, underdevelopment of the posterior parts of the palatine plates). In this case, the posterior edge of the hard palate to which the soft palate is attached appears to be reduced in the form of a corner open to the back. This defect is masked by a soft sky, but as a result of its underdevelopment, the nasopharynx remains open both in the phonation of nasal consonants and in the act of swallowing, which causes open nasal congestion and the entry of liquid food into the nasopharynx. This defect also contributes to the penetration of foreign bodies from the oral cavity in the nasal part of the pharynx. The presence of an uncompensated defect of the soft palate requires a much higher rate of pulmonary air required for phonation, so such patients during a conversation often pause for inspiration. With such defects, the removal of adenoids is contraindicated, since it leads to an increase in tubootids and acute purulent otitis due to more accessible entry into the auditory tube of liquid food.

Treatment of underdevelopment of the soft palate is difficult. The principle of treatment is to narrow the nasopharyngeal cavity, which in the past was realized by introducing paraffin (vaseline) oil into the back wall of the pharynx. Later, various surgical ways of narrowing this space were suggested, one of which is to mobilize the medial plate of the pterygoid process of the sphenoid bone with the pterygoid crochet located on its end and bringing it downward. This process is detected by palpation directly behind and to the inside of the last upper molar, then a direct chisel is struck at its base. This manipulation achieves mobilization of the muscles attached to this process, which are pulled downward by their own thrust and are located on the lower surface of the palatine aponeurosis, which leads to a definite narrowing of the nasopharynx. The operation is performed from two sides.

If this result does not achieve the desired result, then pharyngoplasty is used, the essence of which is to cut a rectangular flap of the mucosa from the posterior pharyngeal wall on the upper feeding leg, after which the back surface of the soft palate is refreshed and fixed to it with a few seams of the lower one end of the flap, the rest of the flap is sewn to the back wall of the pharynx. Thus, the communication between the nasopharynx and the oropharynx is divided into two cavities by a bridge formed from the mucosa of the posterior pharyngeal wall. On the sides of this bridge are preserved lumens, which provide nasal breathing. After this operation, the patient should undergo a course of phoniatric speech therapy.

If the soft palate is partially deficient, a reduction in the space between the missing part and the posterior pharyngeal wall is possible by forming a similar flap on the upper leg opposite to the defect of the soft palate and fixing it with wrapping inward to form a convexity on the posterior wall of the pharynx and reducing the distance between it and the soft palate and ensuring Functional obstruction of the nasopharynx during swallowing and phonation.