The buccinator mucomuscular flap: An in depth analysis and evaluation of its role in the management of velopharyngeal dysfunction

Ahl, Rebecka; Ahmad, Tariq; Harding-Bell, Anne; Wharton, Laura; Jordan, Adam; Hall, Per

doi:10.1016/j.bjps.2014.08.020

Cited by 3 publications

(4 citation statements)

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“…All buccinator flap procedures were carried out by two of the team's consultant plastic surgeons at Addenbrooke's Reconstructive Surgery Department. The buccinator flap procedures were performed with either unilateral or bilateral flaps inset on the oral layer, the nasal layer, or both, and a subset of procedures was carried out with the incorporation of a large mucosal Z-plasty (a separate analysis of outcomes utilizing buccinator flaps combined with Z-plasty has been presented) (Ahl et al, 2012).…”

Section: Methodsmentioning

confidence: 99%

“…The mucomuscular buccinator flap has since been widely used in palatal surgery in patients with cleft to improve speech and function as well as in oral cavity reconstruction after tumor excision. The use of buccinator flaps as a way of adding tissue to, and improving function in, the wider cleft has been practiced and evaluated during previous work in secondary surgery for speech in the Cleft•NET•East (East of England Cleft Lip and Palate Network) team based in Addenbrooke's Cambridge University Hospitals NHS Foundation Trust (Meki et al, 2009; Ahl et al, 2012). The largest case series to date evaluating the buccinator flap in the context of secondary surgery for velopharyngeal dysfunction (VPD) correction was published by Hens et al (2013).…”

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confidence: 99%

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The Buccinator Mucomuscular Flap: An In-Depth Analysis and Evaluation of Its Role in the Management of Velopharyngeal Dysfunction

Ahl

Harding-Bell

Wharton

et al. 2016

The Cleft Palate Craniofacial Journal

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

The Buccinator Mucomuscular Flap: An In-Depth Analysis and Evaluation of Its Role in the Management of Velopharyngeal Dysfunction

Ahl

Harding-Bell

Wharton

et al. 2016

The Cleft Palate Craniofacial Journal

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“…The criteria for recommending surgery are based on perceptual analysis: hypernasality, weak pressure consonants, weak pharyngeal musculature, and nasal emission. Surgical procedures include the enlargement of the posterior pharyngeal wall with various injectable materials, the lengthening of the palate by pushback palatoplasty and ppharyngeal flap, sphincter pharyngoplasty or pharyngeal flap alone [39][40][41][42][43]. Pharyngeal flaps can be based superiorly, inferiorly, or laterally [20].…”

Section: Discussionmentioning

confidence: 99%

Palatal cleft: Results after 18 years, one surgeon, one primary technique

Roessingh¹,

Medinger²,

Broome³

et al. 2020

Otorhinolaryngol Head Neck Surg

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This study reviews the results after 18 years of our surgery and follow-up for children born in our hospital with a cleft palate (CP). Evaluation of 18-year-old youngsters born with CP, operated at the time by the same surgeon following the same primary surgical procedure (von Langenbeck). We analyzed the files of children born from 1997 to 2001 with a CP and operated in our hospital. Operations were performed by the same surgeon, following the von Langenbeck procedure adapted according to the children's age or weight. The evaluation was based on the results of the primary surgeries, final phonatory results, otorhinolaryngology interventions, maxillofacial surgery, and psychological needs. All syndromic children were excluded. Seventy-nine files from children born with a cleft were reviewed: 34 were taken into consideration and among them five Pierre Robin Sequence (PRS) were removed. Children were operated at a median age of 5,2 months (3-6). Eighteen percent had a fistula, 45% had grommets, 14% were operated for a pharyngeal flap following the Sanvenero-Rosselli technique to improve the phonatory score. Thirty-six (36) percent had a final phonation I, 32% a phonation I/II and 32% a phonation IIb. None had an osteotomy. All children were seen by our psychologist. A median of 5.5 multidisciplinary consultations were affected with a median number of general anesthesia of 2.4 (1-6).This retrospective study is based on one primary surgical technique used by the same surgeon. It shows that the von Langenbeck procedure done at six months entails a certain risk of fistula but shows good long-term phonatory results. The number of grommets used is low and must be seen in relation with otitis media and our follow-up. A few complements to our investigations and follow-up are proposed concerning grommets, surgical procedures, and sleep disorder.

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“…Buccinator flap has been used for long time as one of the armamentarium of cleft palate surgery since it was first described by Murkherji (1969) for primary repair of wide cleft palate. Later it was used for various indications including repair of palatal fistula (Bozola et al, 1989), primary repair of wide clefts (Hill et al, 1999), and treating velopharyngeal incompetence (VPI) using a single flap for nasal or oral mucosal lengthening (Robertson et al, 2008; Ahl et al, 2016) or 2 flaps as a sandwich for both oral and nasal mucosal lengthening which is the concern of the current study. This technique is a relatively new evolving procedure with few published reports and encouraging results (Hill et al, 2004; Hens et al, 2013; Denadai et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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

Elsherbiny

Gelany

Mazeed

et al. 2020

The Cleft Palate-Craniofacial Journal

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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.

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The buccinator mucomuscular flap: An in depth analysis and evaluation of its role in the management of velopharyngeal dysfunction

Cited by 3 publications

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The Buccinator Mucomuscular Flap: An In-Depth Analysis and Evaluation of Its Role in the Management of Velopharyngeal Dysfunction

The Buccinator Mucomuscular Flap: An In-Depth Analysis and Evaluation of Its Role in the Management of Velopharyngeal Dysfunction

Palatal cleft: Results after 18 years, one surgeon, one primary technique

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

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