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As in wind instruments, the intraoral pressures generated during playing of brass instruments can be extremely high, and otolaryngologic disorders such as stress velopharyngeal incompetence and laryngoceles can be manifested.
The transoral route provides direct access to the lower clivus and upper cervical spine, but the nasopharynx is still inaccessible unless the surgeon divides the soft palate, which might cause postoperative fistulae and velopharyngeal incompetence.
4] Stress velopharyngeal incompetence has been documented in trumpet and bassoon players.