I was born September 22, 1970 with a “midline cleft of the soft palate”; i.e., a cleft palate. Thankfully, this did not extend as far as my upper lip, and only a short degree into my hard palate. In February of 1972 I had surgery at Seattle Children’s Hospital, for two purposes: 1) insertion of tubes into my ears, as I had chronic ear infections, and 2) repair of the cleft palate. At the time of the surgery, my surgeon noted that the palate still seemed a little short, and suggested that a pharyngeal flap might be necessary in the future.
After this surgery, as I began to talk, it became apparent that I had issues with Velopharyngeal Insufficiency, or VPI. This is a condition in which one cannot make proper closure between the mouth and nasal cavities, resulting in “hyper-nasal” speech. For many words I was unintelligible. So, in 1974 I had about 6 months of intensive speech therapy in Kitsap County, WA. My mother tells me that I was a dedicated patient and worked very hard. Mostly what I remember is being asked to lick peanut butter off the tip of my nose, which I didn't dislike. Still, perhaps that’s the reason I didn’t eat peanut butter for the next 40 years…
Ultimately my speech therapist advised the Maxillofacial Review Board (doctors and surgeons who reviewed my case through the “Crippled Children’s Services” program) that I would not be able to improve any further with speech therapy alone, and recommended that additional surgery be considered. Writing to the board, a speech pathologist agreed:
“At 4 years 7 months of age this boy demonstrated excellent movement of the lateral pharyngeal walls during speech with insufficient palatal length for contact with the posterior pharyngeal wall. At this point, it is unlikely that continued speech therapy will yield significant improvement without changes in the anatomical relationships of the velopharyngeal mechanism. Excellent lateral pharyngeal action makes him a good candidate for a flap procedure.”
The Board agreed, and in August of 1975 I had surgery again with the same surgeon, in which “An inferiorly based pharyngeal flap as wide as the entire posterior pharyngeal wall” was constructed – and is still in place. This tissue connects my soft palate to the back of my pharynx, essentially taking the place of the uvula I don’t have. A uvula creates closure between mouth and nose when you are drinking, eating, and making certain sounds. My pharyngeal flap provides this function, though not perfectly. I am aware of slight hypernasality in my speech at times, occasionally have food escape past the flap into my nasal areas, and cannot make closure to prevent water from coming in my nose, and so must wear a mask when underwater. Still, all the medical professionals I have seen essentially agree that my surgery was done well, that the pharyngeal flap procedure continues to be common practice and has not been replaced by anything more effective, and that they would not wish to disturb the surgical work that was done on me 40 years ago.
Following this surgery my speech improved greatly, and has never been a major impediment since, though I spent many years feeling self-conscious about it. I am aware still of incomplete closure in certain consonants, including initial [k] sounds, [m], [n], and others. However, in the last few years multiple professionals (orthognathic surgeons, ear-nose-and-throat doctors, speech therapists and pathologists, etc.) have all told me that, to their very educated and experienced ears, my speech is near "perfect". I’m not sure if I’m hearing flaws they are not (from my perspective as an experienced and educated listener myself, for vocal tone), but am beginning to think that if no one else is noticing oddities in my speech, perhaps I can just give up that particular well-trodden pathway to low self-esteem.
In the years after my surgery I went through extensive orthodontia for six years (age 10-16) and some additional oral surgery. Teeth were moved from odd positions in my mouth or extracted, and a couple of substitutions of one type of tooth for another were made. It’s not unusual for a medical professional looking in my mouth to say “Whoa!, that’s different.” (In the most professional way, of course.)
In the years following braces, I didn’t understand the need for follow-up care – particularly, wearing a retainer. Though my hygiene was reasonably good, and I was a regular tooth brusher, I didn’t floss. (Now I have seen the light, having learned from a hygienist about the life-cycle of plaque, and for several years been a confirmed flosser.) Also, I went through several years with no health care, and didn’t have basic dental care at that time, let alone guidance on the long-term health of my mouth. I don’t know how much my teeth moved in nearly three decades, but they certainly shifted away from the position my first orthodontist had reached with them.
During my twenties, in the period with little or no dental coverage, I broke all four of my largest molars. A few years later, thankfully, covered by Lorraine’s good health insurance, we were able to have those broken teeth all replaced with crowns. As he replaced them, my dentist at the time told me that due to the positioning of my teeth, my bite was such that those molars, weakened with 1970s-style metal fillings, had been taking the brunt of the pressure of my chewing. This was an early indication that I needed more attention to my teeth, and a return to orthodontia.
Next: A new dentist and a concerned friend spur a massive new Facial Reconstruction Project.
Dr. Adam Burdick has been a professional musician for over two decades. Teaching, conducting, and performing in various music genres, he is also a perpetual student with interest in a wide range of topics. He loves to ponder and share his discoveries with anyone interested!