Palatopharyngeal Incompetence and its Effects
- Palatopharyngeal incompetence refers to the inability to sufficiently close the port between the nasopharynx and oropharynx during speech and swallowing.
- It can result in hypernasal speech and difficulty in understanding the speaker.
- Only three English language phonemes (/m/, /n/, and /ng/) are pronounced with an open palatopharyngeal port.
- Palatopharyngeal incompetence can also lead to nasopharyngeal regurgitation of liquids or solids during swallowing.
- It should not be confused with palatopharyngeal insufficiency, which is the absence of the anatomy responsible for palatopharyngeal closure.

Function of Palatal Lift Prosthesis
- A palatal lift prosthesis physically displaces the dysfunctional soft palate to close the palatopharyngeal port and mitigate hypernasal speech.
- It also prevents nasopharyngeal regurgitation of liquids or solids during swallowing.
- The prosthesis consists of an oral component for stabilization and an oropharyngeal extension to displace the soft palate.
- Palatal lift prostheses can be interim or definitive, depending on the patient's needs.
- Interim prostheses use polymethylmethacrylate and orthodontic wire clasps, while definitive prostheses use cast metallic alloy lamina and retentive clasps.

Interim and Definitive Palatal Lift Prostheses
- Interim palatal lift prostheses are made of polymethylmethacrylate and orthodontic wire clasps.
- They adapt to the hard and soft palatal mucosal surfaces and lingual aspects of the maxillary teeth.
- The retention of an interim prosthesis depends on the presence of healthy maxillary teeth.
- Patients with partial edentulism may have less retentive predictability, especially if they lack posterior maxillary teeth.
- Patients missing anterior maxillary teeth may lack stability and retention without indirect retainers.
- Definitive palatal lift prostheses consist of a cast metallic alloy lamina covering the hard palatal mucosa and lingual aspects of the maxillary teeth.
- They incorporate retentive clasps that engage undercut dental surfaces for enhanced retention.
- The cast metallic portion retains a polymethylmethacrylate oropharyngeal section responsible for elevating the soft palate.
- The retention of a definitive prosthesis is more predictable than an interim prosthesis.
- Both definitive and interim palatal lift prostheses have current dental terminology code numbers for classification.

Palatal Lift Prosthesis Retention
- Dentoalveolar anatomy must be considered for palatal lift prosthesis retention.
- A full complement of healthy maxillary teeth offers greater assurance of retention.
- Partially edentulous patients without suitable posterior maxillary teeth have less retentive predictability.
- Missing anterior maxillary teeth can compromise stability and retention without indirect retainers.
- Patients with compromised retention may be candidates for endosseous titanium implants and abutments to improve retention.

Surgical Alternatives to Palatal Lift Prostheses
- Patients with strong gag reflexes may not tolerate palatal lift prostheses.
- Edentulous or partially edentulous patients may not have enough dental abutments for retention.
- Dental growth, exfoliation, and other dental issues can require multiple prostheses, which may be costly and time-consuming.
- Surgical tactics can be used as an alternative to prosthetic management of palatopharyngeal incompetence.
- Prosthetic management can be a substitute for surgical management when surgical contraindications are present.
- Pharyngeal flap surgery occludes the palatopharyngeal port to manage palatopharyngeal incompetence.
- The procedure maintains patencies between the nasopharynx and oropharynx for nasal respiration and resonance.
- Patients with minimal lateral pharyngeal wall adduction may not be able to close their surgically preserved palatopharyngeal ports.
- Residual palatopharyngeal incompetence may require the fabrication of palatal lift prostheses.
- Pharyngeal flap surgery is often favored as a first option for palatopharyngeal incompetence management.
- Pharyngoplasty is a surgical technique for patients with soft palatal elevation and insufficient lateral pharyngeal wall adduction.
- Incisions are made in the lateral and posterior pharyngeal walls to elevate native tissue.
- The elevated tissues, called flaps, remain pedicled to their native structures for blood flow.
- Flaps are sutured into recipient sites to provide postoperative tissue volume for palatopharyngeal closure.
- Pharyngoplasty carries similar contraindications and complications as pharyngeal flap surgery, including the risk of obstructive sleep apnea.