The causes of secondary defects of the hard and soft palate are mainly unsuccessful operations for congenital clefts, and such diseases as syphilis, tumors and cysts. The difficulty is further increased through repeated operative failures. Ordinarily an opening in the palate can be closed if scarring is not extensive. The two outstanding points in my experience are the relation of the pedicle and the size of the flap. The pedicle should always be toward the rear, and the flap as large as the territory will provide. A small flap is likely to fail and, worse still, may increase the size of the defect.
The illustrations will indicate several flap preparations for the correction of the more or less typical secondary defect. The short palate has been probably the most common failure, and only recently have I succeeded in overcoming this most serious defect. The various flaps from the pillars have