Buccinator Re-Repair (Bs + Re: IVVP): A Combined Procedure to Maximize the Palate Form and Function in Difficult VPI Cases

Abstract

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.

Clinical Findings and Outcomes of Palatal Repair in 9 Patients With Van der Woude Syndrome

“…In the latter, the velar muscles (the levator palati together with the palatopharyngeus on its oral side) are dissected from the nasal mucosal layer (after midline suturing of the nasal layer) and completely released from the tensor tendons and any lateral attachments, until the levator sling can be freely retropositioned as described by Sommerlad 8 . Secondary surgeries for VPI treatment were performed using Sommerlad technique re-repair using radical muscle dissection, with or without buccinator myomucosal flap, depending on palatal length 9 . All patients are still followed by the multidisciplinary team and actively involved in speech therapy.…”

“…8 Secondary surgeries for VPI treatment were performed using Sommerlad technique re-repair using radical muscle dissection, with or without buccinator myomucosal flap, depending on palatal length. 9 All patients are still followed by the multidisciplinary team and actively involved in speech therapy.…”

Comparative Effectiveness of Secondary Furlow and Buccal Myomucosal Flap Lengthening to Treat Velopharyngeal Insufficiency

“…Patients who presented with a small or medium (<5 mm) velopharyngeal gap during phonation received a Furlow while patients presenting with a medium to large gap (≥5 mm) received BMMF. The Furlow procedure was performed as described by Chen et al, 18 and the BMMF procedure was performed as described by Elsherbiny et al 26…”

Update on using buccal myomucosal flaps for patients with cleft palate and velopharyngeal insufficiency: primary and secondary interventions

“…With this approach, all scarred muscular attachments to the hard palate are released with subsequent posterior repositioning of the levator muscular sling. One BMF is then inset in an interpolated manner to fill the nasal defect created by the palatal pushback, while the other BMF is inset into the oral defect [42,[47][48][49][50] (Figs. 2 and 4).…”