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Dentistry · Oral and maxillofacial surgery and facial fractures: velopharyngeal insufficiency
Sample itemA 6-year-old whose cleft palate was repaired at 12 months has hypernasal speech and nasal air escape. Nasendoscopy shows incomplete velopharyngeal closure during speech, and speech therapy has failed. Which operation is appropriate?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Pharyngeal flap
Persistent velopharyngeal insufficiency after therapy is treated by a pharyngeal flap or sphincter pharyngoplasty, which narrows the passage between the pharynx and soft palate.
Option by option
A. Alveolar bone graft
An alveolar graft treats the bony cleft, not speech resonance.
B. Tonsillectomy
Tonsillectomy does not close the gap and can make speech worse.
C. Tympanostomy tube insertion
Tympanostomy tubes treat middle ear effusion, not nasal speech.
D. Pharyngeal flap (correct)
Correct. A pharyngeal flap reduces the velopharyngeal gap.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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