Application of a bulb-type palatal lift prosthesis for velopharyngeal insufficiency due to oropharyngeal cancer resection

Abstract

The use of intraoral appliances is expected to result in early functional recovery of dysphagia and articulation disorders associated with velopharyngeal insufficiency due to oropharyngeal cancer resection. We observed a case of oropharyngeal cancer in which the use of a bulb-type palatal lift prosthesis (bulb-PLP) for dysphagia and an articulation disorder that occurred after resection resulted in favorable recovery. The patient was a 73-year-old man who underwent resection of the right soft palate and the tonsils at the Department of Otorhinolaryngology of our hospital, owing to a diagnosis of oropharyngeal carcinoma (T2N1M0) ; the defect was reconstructed with a tongue flap. Because food regurgitation into the nasal cavity and hypernasality were noticed, he presented to our department for treatment with the use of intraoral appliances. Lateral cephalometric radiographs revealed insufficient soft palate elevation because it did not reach the palatal plane when he pronounced /i:/, and a gap was observed between the posterior pharyngeal wall and the soft palate. His speech was hypernasal, and the nasalance score was >40%. He was diagnosed as velopharyngeal insufficiency, and a bulb-PLP was constructed to compensate for the soft palate elevation and closure insufficiency. After the bulb-PLP was applied, he was able to swallow easily, enabling the transfer of food to the pharynx; the hypernasality resolved, and the nasalance score decreased to ≤20%. Intraoral appliances may be useful for functional recovery after oropharyngeal cancer resection, in addition to soft tissue reconstruction.