Superiorly based pharyngeal flap and posterior pharyngeal wall augmentation

Creating the structural elements necessary for velopharyngeal closure is the essential goal of surgical correction of velopharyngeal insufficiency (VPI). Collaboration with speech pathologists is essential for maximal outcome. The author describes his techniques for surgical correction of VPI using a superiorly based pharyngeal flap, the workhorse for velopharyngeal surgery. In some children with VPI, the defect is more limited, and alternative procedures, which are also described in this articles, exist to correct the resonance problem while minimizing the potential for obstructive complications associated with a pharyngeal flap.