The production of intelligible speech is dependent upon a properly functional velopharynx. A competent velopharyngeal valve serves to separate the oral and nasal cavities during sound production, allowing for control of nasal air emission and resonance. In patients with velopharyngeal dysfunction (VPD), speech is often characterized by hypernasality and perceptible nasal air escape, which may significantly impair speech acceptability and intelligibility. Originally described by Gustav Passavant, the posterior pharyngeal flap (PPF) was one of the first surgical procedures described to address VPD. A posterior pharyngeal flap functions as a static obturator of the velopharyngeal port and can be most effective in patients with adequate lateral pharyngeal wall motion to achieve port closure during speech. A PPF is created by the elevation of posterior pharyngeal wall mucosa along with the underlying superior pharyngeal constrictor muscle. Adequate patient evaluation requires perceptual speech assessment combined with imaging, such as nasopharyngoscopy or multiview video fluoroscopy, for preoperative planning. Postoperatively, patients should be monitored for signs and symptoms of nasal airway obstruction and sleep disordered breathing. With proper patient selection and surgical technique, the pharyngeal flap is a safe and effective modality for the treatment of VPD.