Secondary Surgical Procedures
Secondary surgical procedures are procedures performed after the initial repair of the cleft defects in an effort to improve” speech or correct residual acfects. The most commonly used technique to improve veopharyngeal competence secondarily is the pharyngeal flap procedure
extends posteriorly along the hard palate. D, ~hotograph shows surgical closure of the nasal mucosa
with inversion into the nasal cavity.
(Fig. 27-17). In this procedure a wide vertical strip of pharyngeal mucosa and musculature is raised from the pesterior pharyngeal wall and inserted. into the superior aspect of the soft palate. These flaps are most often based
superiorly. The defect left in the posterior pharyngeal wall from elevation of the pharyngeal flap can be closed »rirnanly or left to heal by secondary intention. Once .nserted into the soft palate, the pharynx and the soft
palate are joined, leaving two lateral portsas the opening between the oropharynx and nasopharynx, which reduces the airstream, between the oropharynx and nasopharynx. The velopharyngeal mechanism then con-
. sists of both rai sing the soft palate somewhat and medialconstncnon of the lateral pharyngeal walls. ~ Another technique that has recently had a resurgence uf interest because of new biocompatible material is the placement of an implant behind the posterior pharyngeal
