Posterior Pharyngeal Flap for Velopharyngeal Insufficiency Patients: A New L-Shaped Flap

Objective:To describe and assess the results of central inset L-shaped posterior pharyngeal flap (PF) for treatment of velopharyngeal incompetence.Methods:This study included 12 patients who were diagnosed as persistent velopharyngeal insufficiency. L-shaped central inset superiorly based PF was harvested from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1cm behind the posterior margin of the hard palate, then the flap was spread 1cm horizontally and 1cm in the anteroposterior direction in soft palate. Before and after surgery, patients were assessed by examination, video: nasoendoscopy, and speech assessment.Results:Postoperative speech assessment showed significant improvement in the nasal emission, resonance, intraoral pressure, and articulation defects. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in all patients. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea reported.Conclusions:The new used L-shaped PF could properly correct velopharyngeal functions (closure and speech) in patients with persistent velopharyngeal insufficiency with no reported complication.