The pathology of the velopharyngeal musculature in cleft palates

This article draws attention to a pathological finding in the cleft palate condition that has not been previously described: It is demonstrated that the palatal aponeurosis exists even in cleft palates, but it is disrupted, malpositioned and folded in 2 layers. It is possible to dissect the 2 layers and to unfold the aponeurosis to form a tough tendinous plane. Thus, the retropositioning of the levator veli palatini muscle sling is facilitated.

For a normal reconstruction of the cleft palate it is not only necessary to reconstruct the levator veli palatini muscle sling but also to approximate and to suture the fibres of the palatal aponeurosis to the corresponding fibres of the opposite side after unfolding them in a mediodorso-cranial direction. In this manner a continuous palatal aponeurosis can be created and subsequently it can serve as a transmitter of the muscle forces.