Radiological Evaluation Of Velopharyngeal Closure

To the Editor.— We wish to add some remarks to the reports (216:2075, 1971) of papers presented by Hogan and Zaborsky at the plastic surgery meeting in Williamsburg, Va, concerned with the success and failure of pharyngeal flaps in eliminating nasality in patients with cleft palate. To achieve velopharyngeal closure, a pharyngeal flap must occupy the space between the lateral pharyngeal walls at their maximum medial movement during phonation. Flap width must be related to the degree of movement of the lateral pharyngeal walls and, therefore, should be individually tailored to the patient. A patient with very active lateral walls and a mobile palate needs a narrow flap, while a subject with poor lateral wall movement needs a wide flap. If the lateral walls exhibit no motion a flap may not be the best treatment. Instead, methods of mechanically stimulating the lateral walls should first be used in an