title: Postoperative evaluation of the folded pharyngeal flap operation for cleft palate patients with velopharyngeal insufficiency.
abstract: BACKGROUND
  Velopharyngeal function is very important for patients with cleft palate to acquire good speech. For patients with velopharyngeal insufficiency, prosthetic speech appliances and speech therapy are applied first, and then pharyngeal flap surgery to improve velopharyngeal function is performed in our hospital. The folded pharyngeal flap operation was first reported by Isshiki and Morimoto in 1975. We usually use a modification of the original method.
  
  
  OBJECTIVE
  The purpose of this research was to introduce our method of the folded pharyngeal flap operation and report the results.
  
  
  METHODS
  The folded pharyngeal flap operation was performed for 110 patients with velopharyngeal insufficiency from 1982 to 2010. Of these, the 97 whose postoperative speech function was evaluated are reported. The cases included 61 males and 36 females, ranging in age from 7 to 50 years. The time from surgery to speech assessment ranged from 5 months to 6 years. In order to evaluate preoperative velopharyngeal function, assessment of speech by a trained speech pathologist, nasopharyngoscopy, and cephalometric radiography with contrast media were performed before surgery, and then the appropriate surgery was selected and performed. Postoperative velopharyngeal function was assessed by a trained speech pathologist.
  
  
  RESULTS
  Of the 97 patients who underwent the folded pharyngeal flap operation, 85 (87.6%) showed velopharyngeal competence, 8 (8.2%) showed marginal velopharyngeal incompetence, and only 2 (2.1%) showed velopharyngeal incompetence; in 2 cases (2.1%), hyponasality was present. Approximately 95% of patients showed improved velopharyngeal function.
  
  
  CONCLUSIONS
  The folded pharyngeal flap operation based on appropriate preoperative assessment has been shown to be an effective method for the treatment of cleft palate patients with velopharyngeal insufficiency.
authors.affiliation: Department of Oral Care for Systemic Health Support, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Hidemi
authors.initials: H
authors.lastname: Yoshimasu
authors.affiliation: Department of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Mishimagi
authors.affiliation: Department of Stomatology and Oral Surgery, Graduate School of Medicine, Gunma University, Gunma, Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Negishi
keywords: Cleft palate; folded pharyngeal flap operation; velopharyngeal insufficiency