Levator Veli Palatini Reconstruction Using an Autologous Tendon Graft in Velopharyngeal Insufficiency: What I Do

BackgroundSevere velopharyngeal insufficiency following salvage surgery poses a major challenge for cleft surgeons, particularly when repeated operations have left the soft palate both shortened and densely scarred.SolutionA tendon graft technique for levator veli palatini reconstruction is described, using an autologous palmaris longus (PL) or, when absent, a flexor carpi radialis (FCR) tendon graft to re-establish the muscular function necessary for velopharyngeal closure.NoveltyUnlike approaches that only address tissue deficiency, this method restores the levator sling by connecting residual muscle stumps with autologous tendon, thereby reconstituting anatomical continuity. In the present case, PL was absent, and FCR was successfully used as the graft.