In 1971, Micheal Hogan introduced the Lateral Port Control Pharyngeal Flap (LPCPF) which obtained good results with elimination of VPI. However, there was a high incidence of hyponasality and OSA. We hypothesized that preoperative assessment with videofluoroscopy and nasal endoscopy would enable modification and customization of the LPCPF and result in improvement in the result in both hyponasality and obstructive apnea while still maintaining results in VPI. Thirty consecutive patients underwent customized LPCPF. All patients had preoperative diagnosis of VPI resulting from cleft palate. Patient underwent either videofluoroscopy or nasal endoscopy prior to the planning of surgery. Based on preoperative velar and pharyngeal movement, patients were assigned to wide, medium, or narrow port designs. Patients with significant lateral motion were given wide ports while patients with minimal movement were given narrow ports. There was a 96.66% success rate in the treatment of VPI with one patient with persistent VPI (3.33%). Six patients had mild hyponasality (20 %). Two patients had initial OSA (6.67%), one of which had OSA which lasted longer than six months (3.33%). The modifications of the original flap description have allowed for success in treatment of VPI along with an acceptably low rate of hyponasality and OSA. 1. Introduction In 1971, Micheal Hogan introduced the lateral port control pharyngeal flap [1–3]. This flap was conceived out of frustration over the inconsistent results obtained in the correction of velopharyngeal insufficiency with pharyngeal flaps. By noting important contributions to the understanding of physiology and dynamics of hypernasal speech by Warren, Isshiki, and Bjork [4–7], he devised a technique that could be universally applied to all patients with velopharyngeal insufficiency and obtain good result with consistent elimination of hypernasal speech [1–3, 8]. In his technique, the superiorly based flap, lined by the nasal side of the soft palate [9–12], was designed so that the lateral aperture size was controlled by the passage of a 4？mm diameter catheter. This effectively created an air passage that allowed the oropharyngeal pressure build up necessary to eliminate hypernasal speech. After his initial description, the procedure evolved due to observation of the results. At the time Hogan described the LPC pharyngeal flap, sleep apnea had not yet been described as a clinical entity [13, 14]. In terms of speech intelligibility, hyponasality is preferred over hypernasality. The idea that many cleft palate patients with VPI
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