Velopharyngeal insufficiency (VPI) is a common problem after cleft palate repair; secondary surgery may be needed to treat this condition. Pharyngeal flap is usually selected for cases with sagittal closure pattern, and sphincter pharyngoplasty is used for cases with coronal closure pattern, whereas cases with circular closure pattern may be puzzling. The objective of this prospective study was to assess the efficacy of tailoring the surgical technique to the preoperative velopharyngeal closure (VPC) pattern and to determine the success of sphincter pharyngoplasty for cases with circular closure pattern.This study was conducted on 48 patients, who presented with postpalatoplasty VPI; the cases were classified into 3 groups according to the VPC: group A of coronal VPC was treated with sphincter pharyngoplasty, group B of sagittal VPC was treated with pharyngeal flap, and group C that exhibited circular VPC was treated with sphincter pharyngoplasty. Speech analysis, nasalance score, and nasopharyngoscopic data were recorded preoperatively and 6 months postoperatively. Also, snoring and sleep apnea were assessed.There were no significant differences between the groups regarding the speech, nasometric, and nasopharyngoscopic data. Although snoring was significantly higher after pharyngeal flap, there was no significant difference regarding apnea.Selection of the surgical procedure depending on the type of preoperative VPC pattern for treatment of postpalatoplasty VPI is an appropriate method. In case of circular closure pattern, sphincter pharyngoplasty is the operation of choice as it has a lower incidence of postoperative snoring than pharyngeal flap.

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Background Specific language impairment (SLI) occurs when children present language maturation, at least 12 months behind their chronological age in the absence of sensory or intellectual deficits, pervasive developmental disorders, evident cerebral damage, and adequate social and emotional conditions. Internalizing behavior is actions that are taken out toward the self. The symptoms of internalizing behavior problems are depression, anxiety, somatic complaints and withdrawal. Aim of the Work This study aimed to investigate the presence of internalizing behavioral problems among SLI and their frequencies if present. Patients and methods We assessed SLI by PLS-4 and assessed internalizing behavioral problems with CBCL 1 1/5-5. Fifty children with SLI with an age range of (4-5 years old), divided into 2 subgroups according to the type of SLI, are compared to fifty children with normal language development with the same age and gender regarding internalizing behavioral problems. Results SLI group had more internalizing behavioral problems than control group and there is significant association between behavioral problems and the severity of language deficits. Conclusion the most frequently behavioral problem found in preschool (SLI) children were withdrawn and anxiety, which need therapeutic interventions to remediate them.

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