Furlow palatoplasty to restore velopharyngeal competence following tonsillectomy avulsion of a pharyngeal flap

Objective: We report the successful use of a Furlow palatoplasty to salvage velopharyngeal competence following iatrogenic avulsion of a pharyngeal fl ap that had been previously established to treat velopharyngeal insufficien cy associated with a submucous cleft palate, Intervention: A tonsillectomy, conducted by a surgeon unaffiliated with a c left palate team, was used to remove enlarged tonsils that had developed af ter pharyngeal flap surgery and extended into the lateral ports causing nas al obstruction and hypernasality because of mechanical interference with po rt closure. A posttonsillectomy evaluation revealed avulsion of the pharyng eal flap, which was successfully treated using a Furlow palatoplasty, Conclusions: To our knowledge, this is the first report of iatrogenic avuls ion of a pharyngeal flap caused by tonsillectomy. Based on a review of the literature and this case experience, we would conclude that tonsillectomy s hould not be regarded as a routine procedure in patients previously treated with a pharyngeal flap. If required, it should be performed by a skilled o tolaryngologist, preferably one affiliated with a multidisciplinary cleft p alate team who is familiar with pharyngoplasty surgery. Finally, our experi ence would suggest that the Furlow palatoplasty is sufficiently robust to b e used as a secondary salvage procedure to restore velopharyngeal sufficien cy following iatrogenic avulsion of a pharyngeal flap.