Robrecht J H Logjes1, Maaike T A van den Aardweg2, Meike M J Blezer3, Anne M B van der Heul4, Corstiaan C Breugem3. 1. Division of Pediatric Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands. Electronic address: r.j.h.logjes@gmail.com. 2. Division of Ear-Nose and Throat Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands. 3. Division of Pediatric Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands. 4. Speech Pathology, Division of Pediatric Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, The Netherlands.
Abstract
PURPOSE: Velopharyngeal insufficiency (VPI) is common (20-30%) after cleft palate closure. The myomucosal buccinator flap has become an important treatment option for velopharyngeal insufficiency; however, published studies all use bilateral buccinator flaps. This study assesses outcomes with a unilateral myomucosal buccinator flap that might result in less operating time and might prevent the need of a bite block and an extra procedure for division of the flap pedicle at a later stage. MATERIALS AND METHODS: Forty-two consecutive patients who underwent a unilateral myomucosal buccinator flap procedure were retrospectively reviewed. Overall clinical judgment of speech, speech analysis, and velopharyngeal closure were evaluated by a multidisciplinary cleft palate team. RESULTS: Median follow-up was 1.2 years. In 83% of patients, overall clinical judgment of optimal speech was obtained and thus no further velopharyngeal surgery was necessary. In 7 patients, further surgery was necessary, of whom 57% (4/7) had bilateral cleft lip-palate. Mean level of intelligibility improved significantly as evaluated by speech pathologists (2.5 ± 0.9 vs 3.5 ± 0.9; P < 0.0001) and by parents (2.1 ± 0.9 vs 3.2 ± 0.7; P < 0.0001). Mean level of resonance improved significantly (0.7 ± 0.9 vs 2.0 ± 1.0; P < 0.0001), and velopharyngeal closure improved in 83% postoperatively. CONCLUSION: The unilateral myomucosal buccinator flap seems to be an effective and safe procedure and should become part of the armamentarium of cleft surgeons.
PURPOSE:Velopharyngeal insufficiency (VPI) is common (20-30%) after cleft palate closure. The myomucosal buccinator flap has become an important treatment option for velopharyngeal insufficiency; however, published studies all use bilateral buccinator flaps. This study assesses outcomes with a unilateral myomucosal buccinator flap that might result in less operating time and might prevent the need of a bite block and an extra procedure for division of the flap pedicle at a later stage. MATERIALS AND METHODS: Forty-two consecutive patients who underwent a unilateral myomucosal buccinator flap procedure were retrospectively reviewed. Overall clinical judgment of speech, speech analysis, and velopharyngeal closure were evaluated by a multidisciplinary cleft palate team. RESULTS: Median follow-up was 1.2 years. In 83% of patients, overall clinical judgment of optimal speech was obtained and thus no further velopharyngeal surgery was necessary. In 7 patients, further surgery was necessary, of whom 57% (4/7) had bilateral cleft lip-palate. Mean level of intelligibility improved significantly as evaluated by speech pathologists (2.5 ± 0.9 vs 3.5 ± 0.9; P < 0.0001) and by parents (2.1 ± 0.9 vs 3.2 ± 0.7; P < 0.0001). Mean level of resonance improved significantly (0.7 ± 0.9 vs 2.0 ± 1.0; P < 0.0001), and velopharyngeal closure improved in 83% postoperatively. CONCLUSION: The unilateral myomucosal buccinator flap seems to be an effective and safe procedure and should become part of the armamentarium of cleft surgeons.
Authors: Nicole M Kurnik; Erica M Weidler; Kari M Lien; Kelly N Cordero; Jessica L Williams; M'hamed Temkit; Stephen P Beals; Davinder J Singh; Thomas J Sitzman Journal: Cleft Palate Craniofac J Date: 2020-02-19
Authors: B J A Smarius; C H A L Guillaume; J Slegers; A B Mink van der Molen; C C Breugem Journal: Clin Oral Investig Date: 2021-02-01 Impact factor: 3.606
Authors: B J A Smarius; C H A L Guillaume; G Jonker; A B Mink van der Molen; C C Breugem Journal: Clin Oral Investig Date: 2018-02-22 Impact factor: 3.573