PMC4441408_01
Preoperative flexible fiberoptic nasopharyngoscopy assessing the palate movement during rest
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F1
All patients attended postoperative speech therapy sessions for 3 months followed by flexible fiberoptic nasopharyngoscopy assessing the palate movement, lateral pharyngeal wall movement, posterior pharyngeal wall movement and pattern of closure and be it either limited or good as shown in Figure 1a and b.
Preoperative flexible fiberoptic nasopharyngoscopy assessing the palate movement, during phonation
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F2
Then, we started the surgery by a midline incision in the soft palate [Figure 2], followed by dissection of both oral and nasal mucosa from the palatal muscle [Figure 3a and b].
Incision of the soft palate
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F3
Then, we started the surgery by a midline incision in the soft palate [Figure 2], followed by dissection of both oral and nasal mucosa from the palatal muscle [Figure 3a and b].
Both oral and nasal mucosa dissected from the palatal muscles, the right palatal muscles hinged by Vicryl suture
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F4
Moreover, suturing the flap to the nasal mucosa, followed by lining of the raw surface of the flap using nasal mucosa of the soft palate to a small triangular from both nasal side of the mucosa covered the undersurface of the flap reduce postoperative contraction [Figure 4a and b].
Both oral and nasal mucosa dissected from the palatal muscles. The left palatal muscles hinged by Vicryl suture
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F5
In addition, posterior displacement of the tensor and levator veli palatini muscles is done by separating them from their abnormal attachment to the posterior palatine edge and opposing them, and then sutured to each other [Figure 5a and b].
Creation of a superiorly based pharyngeal flap
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F6
Then, 4-0 Vicryl sutures are used to sew the oral mucosa [Figure 6].
Suturing the flap to the nasal mucosa
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F7
If the port is too large (the flap is loose around the stent), additional sutures are placed to wrap the flap around the nasal stent (purse string suture on both side of the free area of the flap), could be easily adjustable [Figure 7].