Modified surgical procedure for velopharyngeal closure in adults: a preliminary report

A surgical approach to effect velopharyngeal closure in adults is presented. The three fundamental principles of the procedure are: the complete release of the palatal flap to allow its attachment to the posterior pharyngeal wall without tension; the coaptation of the pharyngeal flap deep into the posterior margin of the velum, with a short and superior based pharyngeal flap that provides a good base for velopharyngeal contact; and the swallow tail division of the pharyngeal flap to form 3 fissural communications between the nasal and oral cavities to maintain physiologic functions. The approach has been applied to eight patients, seven of whom showed no evidence of relapse.