METHOD

The pre-operative velo-pharyngeal distance is a factor in deciding how much soft palate to remove. The soft palate ‘‘dimple,’’ located just behind the levator palati muscle and seen when the palate elevates, is a useful landmark in this decision. It is identified preoperatively, because soft palate excision usually begins just posterior to this point, unless the velopharynx distance is longer than usual. In that case, less soft palate should be removed. Assessment of soft palate movement during speech (saying the letter ‘‘k’’) is also necessary before surgery; occasionally there is bilateral or unilateral limitation of palatal movement secondary to neurologic disease, submucus cleft, or previous tonsillectomy or palate surgery. This may be a contraindication to a UPPP or limit the amount of palate resection.