Velopharyngoplasty – the formation of a permanent graft mucosa, submucosa and muscle between the structures of the soft palate and posterior pharyngeal wall (PPW) to eliminate the VPI (velopharyngeal insufficiency) – approved today by most surgeons. The high positive result of the operation to eliminate the VPI, which is celebrated by many researchers, can create the illusion of simplicity of the technique of surgical intervention. Removal of the palatopharyngeal insufficiency arising from a violation by one sidewall of the pharynx When insufficiency of VPR is due to poor mobility of one of the sidewalls of the pharynx (determined by endoscopy), we propose a surgical method using PF with one of the side-thirds of PPW. Selecting a location of cutting out pharyngeal flap depends on the lower mobility of one of the sidewalls of the pharynx Eliminating palatopharyngeal insufficiency, occurred at the expense of both side walls of the pharynx. Insufficiency of VPR, when the cause of violations of closure are two sides of the pharynx, we use methods to involve the mechanism of closure of the least mobile structures, in this case, both side walls of the pharynx. Method of “purse-string” pharyngoplasty is the following. Removal of the palatopharyngeal insufficiency, resulting from poor mobility of the soft palate, removal of both sidewalls of the pharynx by cutting out pharyngeal flaps on the upper leg in the lateral thirds of the posterior wall, followed by suturing them to the tissues of the LPW (lateral pharyngeal wall) and the soft palate tissue. At the same flap the wound surface of the pharyngeal tissues are closed with sidewalls of the pharynx and soft palate tissues (Ad. Mamedov, 1996).

Key words: velopharyngeal ring; velopharyngeal insufficiency; lateral pharyngeal wall; palatine vellum