This results in a situation with the same symptoms of hypernasality after a few weeks of surgery. Also a fistula can occur in 2.4% of the cases. Sphincter palatoplasty
When the sphincter pharyngoplasty is used, both sides of the superior-based palatopharyngeal mucosa and muscle flaps are elevated. Because the distal parts (posterior tonsillar pillars, which the palatopharyngeal muscles are attached to) are sutured to the other side of the posterior wall, the pharyngeal port will become smaller. As a result, the tissue flaps cross each other, leading to a smaller port in the middle and a shorter distance between the palate and posterior pharyngeal wall.There are a few advantages with using this technique. First of all the procedure is relatively easy to execute. This makes the operation cheaper, also because of a reduced anesthesia time. Secondly the dynamic sphincter can be moved as result of a remaining neuromuscular innervation, which gives a better function of the velopharyngeal port. Finally there is a lower complication rate, although obstructive sleep apnoea syndrome (OSAS) is associated.Both techniques are used often, but there is no standard operation. Pharyngeal flap surgery is not better than sphincter palatoplasty. It is more upon the surgeons experience, knowledge and preference which operation will be done. Also the patient’s age, and the size and nature of the velopharyngeal defect, contribute to which technique is used. Posterior wall augmentation
Another option for diminishing the velopharyngeal port is posterior wall augmentation. This technique is not often used. Additionally this technique can only be used for small gaps.
Medical use
In the United States, lanadelumab is indicated for patients 12 years and older for the prophylaxis of hereditary angioedema (HAE) attacks. There is no data on the efficacy or safety of lanadelumab in patients under the age of 12 years old. Lanadelumab was not studied in pregnant or breastfeeding women. Adverse events
In a phase 3 randomized controlled trial, which examined the efficacy and safety of lanadelumab in preventing hereditary angioedema attacks, the most common adverse events noted in patients being treated were:
Injection site pain in 42.9% of patients
Viral upper respiratory tract infection in 23.8% of patients
Headache in 20.2% of patients
Injection site erythema in 95% of patients
Injection site bruising in 7.1% of patients
Dizziness in 6.0% of patients

Mechanism of action
Lanadelumab works by binding to an enzyme within the plasma, kallikrein, to inhibit its activity. Kallikrein is a protease that functions to cleave kininogen, subsequently creating kininogen and bradykinin, a potent vasodilator.Patients have hereditary angioedema (HAE) because of a deficiency or dysfunctional C1 inhibitor, which is an enzyme that regulates the activity of the kallikrein-kinin cascade. Poor regulation of the C1 inhibitor results in increased levels of kallikrein and subsequent proteolysis of kininogen. The proteolysis of the kininogen forces an upscaled production of bradykinin and kininogen within the patient. Increased bradykinin levels cause vasodilation, increased vascular permeability, and the succeeding angioedema and pain associated with hereditary angioedema attacks.