Objectives: To assess the outcome of a modified buccinator flaps’ palatal lengthening combined with radical intravelar veloplasty (Bs + Re: IVVP) for the management of postpalatoplasty velopharyngeal incompetence and report the functional and structural changes occurring in the palate. Design: Prospective cohort study of consecutive cleft patients presenting with velopharyngeal incompetence and managed by buccinator re-repair procedure. Blind assessment of randomized recordings of speech and evaluation of velar form and function with nasoendoscopy and lateral videofluoroscopy were done. Patients’ demographic data were also collected. Patients: Among 30 consecutive cases who had Bs + Re: IVVP, 24 had adequate pre- and postoperative records of speech outcome data. Setting: Multidisciplinary cleft team in a tertiary referral center. Results: There were significant improvements in hypernasality, nasal emission, facial grimace and weak consonants, and overall intelligibility of speech. Endoscopy and lateral videofluoroscopy showed significant improvement in total and functional velar length, closure ratio, velopharyngeal gap at closure, palatal thickness, palatal convexity, and mobility. Regarding the procedure complications, no flap ischemia, fistula, or obstructive sleep apnea reported, but there were one cheek hematoma and two minor oral mucosal dehiscence which healed spontaneously. Conclusions: Buccinator re-repair (Bs + Re: IVVP) has been shown to be an effective and safe procedure in treating difficult postpalatoplasty velopharyngeal incompetence. It was also shown that it is still a physiological nonobstructive procedure with low morbidity.

Anatomy of the Velopharyngeal Valve (a)Ahmed El Sayed Gelaney and (b)Abeer Fareed Abd El-Naeem (a)Lecturer of phoniatrics . Faculty of Medicine. sohag university. (b) Lecturer of human anatomy and embryology. Faculty of Medicine. sohag university.

This study was designed to comparesubjective and objective assessment of lateral videoflruroscopyin patients with velopharyngeal valve incompetence. It is prospective randomized blind study of lateral videofluroscopic recordings whether subjectively by 3 different examiners or objectively.19 consecutive patients with previously repaired cleft palates and symptomatic velopharyngeal incompetence (VPI). The results of this study no significant difference between subjective and objective evaluation of velar length (P value =0.113) or velar thickness (P value = 0.752). So subjective assessment of velar length and thickness is effective in comparison with objective assessment and further research on a big sized sample is recommended.