Tissue from the posterior pharyngeal wall is attached to the soft palate, creating a midline subtotal obstruction of the oral and nasal cavities with 2 small lateral openings, or ports that ideally remain patent during respiration and nasal consonant production and close for oral consonants.
The soft palate is incised in the Sagittal midline from the Uvula toward the junction of the soft and hard palate. The superiorly based pharyngeal flap is elevated off the prevertebral fascia. The flap is inset to the soft palate and sutured to the nasal side of the soft palate with interrupted sutures. The donor site is partially closed with 3-0 Vicryl sutures. Nasopharyngeal airways are placed through each lateral pharyngeal port for sizing and postoperative airway support. With the flap inset and the nasal side closed, the soft palate musculature is further dissected and approximated as indicated. The oral side of the soft palate is then closed with interrupted sutures.
Through the years, several problems and complications have been identified with the pharyngeal flap procedure. As a result, it has undergone several modifications. The problems include construction of the appropriate width of flap, the use of a superiorly or inferiorly based flap, and whether the flap should be lined. A higher surgical success rate can probably be achieved by taking into account an individual patient's pattern of VPD. How to precisely tailor the flap to balance speech and airway is patient-dependent and objectively difficult to elucidate.