Attachment of a posterior pharyngeal flap is commonly performed for the surgical management of velopharyngeal insufficiency. Obstructive sleep apnea has been found to occur in as many as 38% of patients undergoing posterior pharyngeal flap attachment. Often, this is temporary in the early postoperative period. When it occurs later after surgery, however, it can require active treatment. Many patients improve with the use of nighttime nasal C-PAP. Those patients who do not improve sufficiently with nasal C-PAP may require surgical flap division. We report surgical flap division in 12 such patients. All patients had preoperative and postoperative perceptual speech evaluations, and most had preoperative and postoperative pressure flow studies. In 11 of the 12 patients who underwent surgical flap division, velopharyngeal function did not deteriorate. We hypothesized that the persistence of the speech improvement in those patients is either secondary to the bulk of tissue from the flap, which remains in the posterior pharyngeal wall and provides a pad to assist with velopharyngeal closure, or is secondary to the speech mechanisms that the patients learned with the flap in place and were able to continue even after flap division.
Chapel Hill, North Carolina
From the *Division of Plastic Surgery, University of North Carolina School of Medicine, Chapel Hill; †Division of Speech and Hearing, University of North Carolina Craniofacial Center, Chapel Hill; and ‡Division of Plastic Surgery, East Carolina University, Greenville, North Carolina.
Address correspondence to Dr Agarwal, Division of Plastic Surgery, University of North Carolina School of Medicine, Bioinformatics Bldg., Suite 2100, CB 7195, Chapel Hill, NC 27955, e-mail: email@example.com