Which strategy is least favourable for dealing with velopharyngeal incompetence?
A. Hynes pharyngoplastyPosterior pharyngeal wall augmentation. This is the least favourable strategy. Hynes from Sheffield UK delivered his Hunterian Oration on his sphincter pharyngoplasty technique in 1953. This involved use of the salpingopharyngeus muscle, but it was developed to later include a greater amount of musculature including palatopharyngeus. Orticochea from Bogota in Colombia, described an inferiorly-based pharyngeal flap in conjunction with sphincter pharyngoplasty. Intravelar veloplasty has been popularised by Sommerlad. These, along with Furlow’s double-opposing Zplasty soft palate repair, are useful strategies for velopharyngeal incompetence. Veau’s push-back repair lengthens the soft palate and has theoretical advantages, but has fallen out of favour as it causes unacceptable midfacial hypoplasia. Augmentation of the posterior pharyngeal wall with fillers ranging from Teflon® to autologous fat have not, as yet, been successful to the extent that they have been widely adopted.