Superiorly based pharyngeal flap.

First described in 1875 by Schoenborn as an inferiorly based flap, the pharyngeal flap is the most common surgical procedure performed for velopharyngeal insufficiency. Having undergone numerous modifications since its conception, the pharyngeal flap is now primarily designed as a superiorly based flap and is most effective for patients with good lateral wall motion but limited anterior-posterior motion due to poor palatal excursion. The primary aims of this chapter are to provide the clinician with indications for when to consider utilizing the superiorly based pharyngeal flap and to give a stepwise description of how to perform the procedure.