The Pushback Pharyngeal Flap

What is it about?

Velopharyngeal insufficiency (VPI) results from poor closure of the velopharyngeal valve. This condition can be associated with cleft palate, but may also occur independently of cleft palate such as in congenital VPI or velocardiofacial syndrome. The pharyngeal flap is one of the oldest and most popular techniques for VPI correction. We describe a series of 40 cases over 17 years utilizing a technique that combines a pharyngeal flap with a palate pushback to avoid common causes of failed surgeries. Advantages of this technique include high, secure flap inset with prevention of palatal scar contracture and shortening. Comparison of pre- and postoperative assessments showed significant improvements in speech metrics (hypernasality, nasal air emission, consonant strength, and nasal acoustic energy), as well as few complications. We conclude that the pushback pharyngeal flap is a safe and effective treatment of VPI.

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