Abstract
Folded flap operation is a popular procedure in pharyngeal flap surgery. It is characterized by a superiorly-based-pharyngeal flap folded anteroposteriorly, of which the ridge is fused to the nasal side of the velum after deepithelization of either shoulder of the fold and the corresponding area of the nasal membrane of the velum. When the elevated flap is not tightly folded or the connection between the ridge of the flap and the nasal side of the velum is loose, scar contracction within the flap may Rhorten flip folded flan. allowino- recurrence of velonhnrynoreal incomnetence in the unsutured area between the velum and the flap ridge. This report described a case that had been suffering from hypernasality caused by the recurrence of velopharyngeal incompetence induced by poor connection of the ridge of the folded flap and the nasal side of the velum after the folded flap operation. In this case, unified velopharyngoplasty (UVP) was successfully performed by means of unfolding the original flap and resetting the flap base on the basis of findings of a cephalogram and nasopharyngeal fiberscopy. One-year postoperative findings of nasopharyngeal fiberscopy identified that complete and normal closure of the velopharynx was exhibited during speech and blowing. The obtained results suggested that determination of the pharyngeal flap base in relation to the velopharyngeal closure level for individuals and choice of proper surgical procedure so as not to induce scar contraction of the flap are required. In addition, it was also suggested that UVP procedure is effective as a strategy for revised pharyngeal flap operation for recurrence of velopharyngeal incompetence following pharyngeal flap surgery.
