Repeated superiorly based pharyngeal flap operation for persistent velopharyngeal incompetence.

: A secondary pharyngeal flap procedure, superimposed, on the primary flap, is described after having successfully improved the speech of the three patients on whom it has been used. The raising of a secondary flap is made possible by the fact that minimal scarring occurs from previous pharyngeal flap surgery and also because of the presence of a muscle layer. The combination of factors leading to further reduction in the size of the velopharyngeal lumen is discussed. This operation offers some measure of hope for the not insignificant number of patients who have been left with poor speech after pharyngeal flap surgery and supports the recent work of Cosman and Falk (2).