Superiorly based flap pharyngoplasty: the degree of postoperative "tubing" and its effect on speech

It is recognised that superiorly based pharyngeal flaps tend to contract resulting in narrowing and lowering of the flaps. If lateral pharyngeal-wall motion is unable to close against the "tubed" flap or if the flap migrates below the level of medial displacement of the lateral pharyngeal walls, velopharyngeal insufficiency will result. The extent of this phenomenon of flap contracture or shrinkage has not been previously quantified. A consecutive series of 120 superior flap pharyngoplasty operations were assessed critically and carefully. The mean width of the harvested flap measured 89% of the width of the pharyngeal posterior wall and shrank over 6 months to 45% of the lateral pharyngeal diameter. The relations between speech results, complication rate and remaining flap width are analysed. All flaps shrink but to a varying degree.