Naoshige Iida, Ayako Watanabe, Setsuko Shoji, Yosuke Ando The modified folded pharyngeal flap operation for the treatment of velopharyngeal insufficiency  Naoshige Iida, Ayako Watanabe, Setsuko Shoji, Yosuke Ando  JPRAS Open  Volume 11, Pages 28-32 (March 2017) DOI: 10.1016/j.jpra.2016.12.004 Copyright © 2017 The Author(s) Terms and Conditions

Figure 1 Diagram of the surgical methods. A: The first incision is made on the soft palate. B: The mucosa on the nasal side is horizontally incised. The dotted line indicates the incision site. C: The raised flap is folded and sutured. D: A full-thickness incision is made on both sides at points shifted from each other, in a stepwise manner. E: Two threads are applied to each side of the created wound. F: The flap is fixed to the soft palate by means of horizontal mattress suturing. G: Fixation of the pharyngeal flap on the soft palate is performed at the level of the posterior palatine arch. JPRAS Open 2017 11, 28-32DOI: (10.1016/j.jpra.2016.12.004) Copyright © 2017 The Author(s) Terms and Conditions

Figure 2 Case 1. The patient was a 7-year-old boy with a congenital velopharyngeal insufficiency. He had received speech training but his hypernasal speech and dysarthria were not alleviated. Because the mobility of the pharyngeal side wall was confirmed to be good, he underwent pharyngeal flap surgery with our method. At present, 2 years after the operation, he is showing clinical improvement of speech functions. a: Preoperative resting condition on lateral cephalometric radiography. b: The velopharyngeal gap size is 15 mm during phonation. c: Postoperative resting condition on lateral cephalometric radiography. d: The velopharyngeal closure is sufficient during phonation. JPRAS Open 2017 11, 28-32DOI: (10.1016/j.jpra.2016.12.004) Copyright © 2017 The Author(s) Terms and Conditions