Soft palate underdevelopment: causes, symptoms, diagnosis, treatment

Underdevelopment of the soft palate is due to a disruption in the development of the embryonic rudiments of the palatine plates, which can also lead to an anomaly in the development of the hard palate (Gothic vault 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 reduced in the form of an angle open posteriorly. This defect is masked by the soft palate, but as a result of its underdevelopment, the nasopharynx remains open both during the phonation of nasal consonants and during the act of swallowing, which causes open nasality and the entry of liquid food into the nasopharynx. This defect also contributes to the penetration of foreign bodies from the oral cavity into the nasal part of the pharynx. The presence of an uncompensated defect of the soft palate requires a significantly greater consumption of pulmonary air necessary for phonation, which is why such patients make frequent pauses for inspiration during a conversation. In such defects, removal of adenoids is contraindicated, since it leads to an increase in the frequency of tubootitis and acute purulent otitis due to the more accessible entry of liquid food into the auditory tube.

Treatment of underdevelopment of the soft palate is difficult. The principle of treatment is to narrow the nasopharyngeal cavity, which in the past was achieved by introducing paraffin (vaseline) oil into the back wall of the pharynx. Later, various surgical methods of narrowing this space were proposed, one of which is to mobilize the medial plate of the pterygoid process of the sphenoid bone with the pterygoid hook located at its end and lowering it downwards. This process is detected by palpation directly behind and inwards from the last upper molar, then a blow is delivered to its base with a straight chisel. This manipulation achieves mobilization of the muscles attached to this process, which, by their own traction, descend downwards and are located on the lower surface of the palatine aponeurosis, which leads to a certain narrowing of the nasopharynx. The operation is performed on both sides.

If this surgical intervention does not achieve the desired result, then pharyngoplasty is used, the essence of which is to cut out a rectangular flap of mucous membrane from the back wall of the pharynx on the upper feeding pedicle, after which the back surface of the soft palate is refreshed and the lower end of the flap is fixed to it with several sutures, 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 mucous membrane of the back wall of the pharynx. Gaps are preserved on the sides of this bridge, ensuring nasal breathing. After this operation, the patient must undergo a course of phoniatric speech therapy.

In case of partial insufficiency of the soft palate, it is possible to reduce the space between the missing part and the back wall of the pharynx by forming a similar flap on the upper leg opposite the defect of the soft palate and fixing it by turning it inward to form a bulge on the back wall of the pharynx and reduce the distance between it and the soft palate and ensure functional obturation of the nasopharynx during swallowing and phonation.