Arrow Revision Palatoplasty: A Novel Technique for Soft-Palate Revision in Patients with Velopharyngeal Insufficiency and a Large Pharyngeal Gap.

Up to 30% of patients undergoing primary palatoplasty require secondary surgery due to velopharyngeal insufficiency (VPI). In patients with a large pharyngeal gap seen on nasoendoscopy, surgical intervention may risk the development of obstructive sleep apnea. Many surgical techniques are available to address VPI, but for patients with VPI and a large pharyngeal gap, there are limited surgical options available that do not require obstruction of the pharyngeal airspace with tissue flaps or implants. The authors describe arrow revision palatoplasty, a novel technique that combines revision palatoplasty and buccal flaps to concurrently reconstruct the levator sling and lengthen the palate without the creation of obstructive flaps within the pharynx. Changes in video speech nasopharyngeal endoscopy and perceptual speech analysis were evaluated in 13 patients undergoing arrow revision palatoplasty.