Abstract
Pharyngeal flap surgery is used in the prevention of hypernasality and the devel-opment of articulation disorders that are associated with velopharyngeal incompetence after primary palatal closure. However, surgery may result in failure when the level of the pharyngeal flap base is not determined properly with relation to that of velopharyngeal move-ment or when the flap shrinks because of scar contraction through prolonged exposure of its raw surface. This report describes one patient who had suffered from recurrence of velopharyngeal incompetence after pharyngeal flap surgery. Lateral cephalographic and nasopharyngeal fiberscopic examinations identified the cause of flap atrophy to be marked scar contraction, and the flap base was remarkably lower than the level of velopharyngeal closure in the patient. Unified velopharyngoplasty was newly performed on the basis of find-ings obtained from lateral cephalographic and nasopharyngeal fiberscopic examinations to correct the recurrence of velopharyngeal incompetence in the patient. One year postoperatively, complete closure of the velopharynx in coordination of the flap during speech was confirmed by nasopharyngeal fiberscopy.
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