Prosthodontic aspects of palatal elevation and palatopharyngeal stimulation.

The prosthodontic aspects of palatal elevation and palatopharyngeal stimulation were discussed. Following are important factors that must be considered. (1) Elevation of the soft palate should be gradual to avoid placing pressure upon the teeth retaining the prosthesis and to reduce mucosal irritation. (2) Prosthetic stimulation should be initiated as soon as palatal paralysis is noted to prevent palatal disuse atrophy. (3) The palatal lift prosthesis may be used as a temporary or definitive treatment for palatal incompetency. When adequate elevation of the soft palate has been achieved, the prosthesis may be discarded. Otherwise, the patient would wear the prosthesis as a permanent supportive device. (4) The construction of the combined palatal lift/pharyngeal section prosthesis includes the gradual palatal elevation and molding of the pharyngeal section to reduce the gag reflexes and to increase palatopharyngeal muscle adaptation to the prosthesis. After the initial placement, adjustment to the pharyngeal section is easier for the patient. (5) Speech and myofunctional therapy should be instituted in conjunction with prosthetic treatment. (6) The palatal lift and combination prostheses are more effective for patients with less severe neurologic impairment and speech articulatory problems. (7) The palatal lift prosthesis is more effective for those patients with palatal incompetency who have no involvement of the other oropharyngeal muscles. The combination type of prosthesis is more effective for patients with palatopharyngeal insufficiency without marked speech articulatory disorders. There are still several questions which require further investigation. These include: (1) What is the relationship between the palatal stimulation and the degree of neuromuscular function and recovery? (2) What is the relationship between the palatal stimulation and the degree of palatal disuse atrophy? (3) What is the relationship between pharyngeal stimulation and muscle contraction? (4) What is the degree of stability of palatopharyngeal function and muscle contraction after stimulation?