De-mucosalized pharyngeal flap: a modified technique for selected cases of velopharyngeal insufficiency

Superiorly based posterior pharyngeal flap is performed via rotation of tissues of the posterior pharyngeal wall anteriorly and anchoring it to the soft palate. Unfortunately, bad healing of the donor site defect might be a considerable cause of morbidity of the surgery. With some modifications of flap elevation we could achieve better surgical outcomes. The aim of this study was to present the new modification of the conventional maneuver and its surgical/functional outcomes. The study design is a case series. 17 patients underwent the de-mucosalized superiorly based pharyngeal flap for the treatment of velopharyngeal insufficiency. A wide laterally based (mucosa-only) flap was elevated off the submucosa of the posterior pharyngeal wall and then a superiorly based posterior pharyngeal flap (bared of its covering mucosa) was elevated and sutured to the palate. The mucosal flap was draped over the bed and sutured. No significant complications as airway problems, infection and bleeding were reported. Also, the postoperative pain was tolerable and there were no reports of neck rigidity with early ambulation; VAS showed significant improvement. No patients showed flap dehiscence or palatal fistula. Speech assessment showed improvement. The modified de-mucosalized, superiorly based pharyngeal flap technique ensured self-mucosal draping of the bed, thus it would enhance primary healing and decrease postoperative pain with the resultant early ambulation. We believe that the new modified technique could correct VPI, in addition to the improvement of patients' comfort and decrease the morbidity of the procedure.