Pharyngeal Flap Revisions: Flap Elevation from a Scarred Posterior Pharynx

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Twenty-one consecutive patients who had earlier superiorly based pharyngeal flap surgery and persistent velo-pharyngeal insufficiency were seen between 1976 and 1991. Patients were divided into two treatment groups, depending on the results of videofluoroscopic and naso-pharyngoscopic assessment. The first group consisted of 18 patients who had bilateral port insufficiency and required a complete reconstruction of a new superiorly based pharyngeal flap that was elevated from a scarred posterior pharyngeal wall. After an average follow-up of 6.2 years, 15 patients had normal resonance, 2 patients had improvement but continued hypernasality, and 1 patient was hyponasal. The second group consisted of 3 patients who had “patch” flaps to a unilateral port insufficiency. Postoperatively, all 3 of those patients had normal resonance. Indications for the decision to “redo” or patch flaps are described. (Plast. Reconstr. Surg. 93: 279, 1994.)

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