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Abstract

 Upper oesophageal sphincter aplasia and subsequent incompetence had been reported as one element of the fourth branchial arch defect syndrome and also as a possible sequelae to the placement of a laryngeal abductor prosthesis. Fourth branchial arch defects were thought to be uncommon and when diagnosed it was more often the cartilaginous abnormalities with associated arytenoid abductor incompetence that were discussed. As a consequence of introducing manual assessments of upper oesophageal sphincter tone to the oropharyngeal examination performed prior to palatoplasty procedures, it was determined that this presentation was more common than previously reported. In addition and as a result of pre and post operative examinations and history collection there appeared to be a possible association in some instances with cases of dorsal pharyngeal collapse and paradoxical sleep deprivation.