Outcome measures:
  1. A subjective measure of NPS by upper airways endoscopy and oral cavity exploration.
  2. Baseline, 4weeks, 3months, and 1-year Visual Analog Scale (VAS 0–10) for nasal breathing, snoring by bed partner,and dysphagia (0 “no complaints” to 10 “severe complaint”).
  3. Baseline and 1-year follow-up polysomnography.
  4. Short term morbidity and adverse events especially VPI.
Surgical technique (figure 1,2)Under general anaesthesia and patient’ssupine position, mouth gag was inserted. The operative site was infiltrated with 1% lidocaine with 1:100,000 epinephrine solution.A butterfly mucosal flaps were designed, marked, elevated and removed from the oral surface of the soft palate with caution to preserve the soft palate nasal mucosa. Then, the soft palate was divided in the midline paying attention not to injure the posterior pharyngeal wall mucosa. Excessive soft palate scar tissue was removed as required to facilitate eversion and suturing of the nasal mucosal surface to the oral side. Vicryl suture was placed on the edge of each side of the divided palate to facilitate its eversion. The closure was done in a centrifugal direction by vicryl in 2 layers; 1st one is submucosal inverted sutures and 2nd one is horizontal mattress mucosal sutures without tension and keeping the stitches on the oral side, not on theedge.By this way, we aim to change the scar contracture tension lines to anterolateral vectors and to widen the anteroposterior and lateral oropharyngeal air spaces at palatal level. All patients received postoperative paracetamol, antibiotics and steroids, and asked to maintain on soft diet and fluids for 2 weeks. TheSPSS program version 20 (Chicago, Illinois, USA) was used for statistical analysis. P-value <0.05 was considered significant.