The modified folded pharyngeal flap operation for the treatment of velopharyngeal insufficiency

Pharyngeal flaps have a long-established place in surgery for velopharyngeal insufficiency and many designs of pharyngeal flap have been described. Here we describe a modification of the folded pharyngeal flap operation by Issiki. With our procedure, the base of the pharyngeal flap is located at the level of the lower edge of the palatine tonsil, with the width of the flap designed to be 15 mm. The pharyngeal flap tip is located slightly above the epiglottis. Then, the raised pharyngeal flap is folded and sutured. The folded part of the pharyngeal flap is lifted with a hook; subsequently, a full-thickness incision of 4 mm is made on both sides. Two 4-0 vicryl threads are applied to each side of the created wound, followed by suturing to the mucosa on the nasal side. We performed this method on seven cases with velopharyngeal insufficiency. The patients did not develop complications after the surgery with this procedure. Visual inspection of the oral cavity and lateral cephalometric radiography confirmed that the flap was fixed at a favorable position in relation to the soft palate in all cases. After 6 months of speech training, all cases showed improvement in the velopharyngeal function. With our procedure, a full-thickness incision is made on both sides at the folded part of the flap. Therefore, a wide area of the wound can be sutured to the soft palate. This procedure, which is both rational and simple, was found to be useful.