of the flap to tailor the port size to the perception of nasal resonance (Sloan, 2000). Consistent with Warren’s aerodynamic data, Hogan advocated that the velopharyngeal opening be no greater than 4 mm in diameter because a larger gap would most likely result in hypernasal speech (Peterson-Falzone et al., 2001). In 1979, Shprintzen advocated ‘tailor-made’ flaps, with the width of the flap determined by the degree of preoperative lateral pharyngeal wall adduction. According to Shprintzen, the base of the pharyngeal flap should be positioned at the site with the greatest level of lateral pharyngeal wall movement. In addition, Shprintzen recommends that a narrower flap be used with pronounced lateral pharyngeal wall movement, while a wider flap should be used with limited lateral pharyngeal wall movement. (Sloan, 2000) Use of a narrow flap in individuals with limited preoperative lateral pharyngeal wall movement has the potential to increase lateral pharyngeal wall movement postoperatively (Karling et al., 1999). Candidacy Pharyngeal flap surgery may be recommended to resolve velopharyngeal inadequacy after patients prove unable to achieve significant speech improvements through speech therapy alone. Other requirements to qualify for the surgery include a short and immobile or easily fatigued palate (Mazaheri et al., 1994). The patient’s pattern of VP closure is one aspect that is taken take into consideration by doctors in deciding whether pharyngeal flap surgery is the appropriate method of treatment (Armour et al., 2005). A variety of closure patterns have been found, and the pattern varies person to person. When planning pharyngeal flap surgery, it is imperative for the doctor to match the postoperative structure to the preoperative movements in order for an adequate seal to be achieved (Ysunza et al., 2002). Research has found that pharyngeal flap surgery has been most effective for those with a sagittal closure pattern (good lateral wall movement but poor velar movement (Armour et al., 2005)). Pharyngeal flap surgery is not recommended for everyone and alternative treatment methods are available. One alternative is the use of a prosthesis. In some instances, a prosthesis is capable of stimulating pharyngeal wall movement, thus aiding in VP closure. Most often, prostheses have been recommended for use in young children (Mazaheri et al., 1994). Currently, no accurate method is available to determine whether a pharyngeal flap or an alternative method will have better results for eliminating velopharnygeal incompetence. Pharyngeal flap surgery has been completed in both children and adults. When