title: Modified superior pharyngeal flap for the treatment of velopharyngeal insufficiency in children.
abstract: OBJECTIVE
  To describe a modified rolled superior pharyngeal flap for treatment of velopharyngeal insufficiency (VPI) in children.
  
  
  METHODS
  Prospective case series at a tertiary care multidisciplinary aerodigestive center. Four children, aged 5-12 years, with VPI refractory to speech therapy resulting after cleft palate (bilateral, submucous, or soft palate only) repair, failed traditional superior pharyngeal flap, fine motor incoordination, or adenoidectomy were studied. All 4 children underwent surgery with a modified superior pharyngeal flap, where aspects of the most commonly employed pharyngeal flap designs were combined to achieve the benefits of each technique and to allow for mucosal covering on either side of the flap, improved control of the lateral port size due to the horizontal-to-horizontal inset technique, and the ability to avoid a vertical or horizontal split in a previously repaired cleft palate.
  
  
  RESULTS
  All 4 patients demonstrated resolution of their VPI as measured by subjective and/or objective criteria. Every patient required additional speech therapy postoperatively.
  
  
  CONCLUSIONS
  Our modified superior pharyngeal flap technique may be a good option in patients with small velopharyngeal gaps undergoing revision velopharyngeal surgery. A larger, longitudinal study would better address the overall outcomes of this technique.
authors.affiliation: Pediatric Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, MA, United States.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Rogers
authors.forename: Jean E
authors.initials: JE
authors.lastname: Ashland
authors.forename: Marie J
authors.initials: MJ
authors.lastname: Rozeboom
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hartnick
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010614:Pharynx / Q000601:surgery*; D011446:Prospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery*