"Buccal Myomucosal Flap Repair for Velopharyngeal Dysfunction."

Abstract

Velopharyngeal dysfunction is the incomplete separation of the nasal and oral cavities during speech sound production that can persist following primary palatoplasty. Surgical technique used in management of velopharyngeal dysfunction (palatal re-repair versus pharyngeal flap or sphincter pharyngoplasty) is often dictated by the preoperative velar closing ratio and closure pattern. Recently, buccal flaps have increased in popularity in management of velopharyngeal dysfunction. Here, we investigate the effectiveness of buccal myomucosal flaps in the treatment of velopharyngeal dysfunction. A retrospective review was performed of all patients undergoing secondary palatoplasty with buccal flaps at a single center between 2016-2021. Pre- and postoperative speech outcomes were compared. Speech assessments included perceptual examinations, graded on a four-point scale of hypernasality, and speech videofluoroscopy, from which velar closing ratio was obtained. A total of 25 patients underwent buccal myomucosal flap procedures for velopharyngeal dysfunction at a median of 7.1 years after primary palatoplasty. Patients had significantly increased velar closing postoperatively (95% vs 50%, p<0.001) and improved speech scores (p<0.001). Three patients (12%) had continued hypernasality postoperatively. There were no occurrences of obstructive sleep apnea. :' Treatment of velopharyngeal dysfunction with buccal myomucosal flaps leads to improved speech outcomes without the risk of obstructive sleep apnea. Traditionally, palatal re-repair techniques have been utilized for smaller preoperative velopharyngeal gaps; however, the addition of buccal flaps allows for anatomic velar muscle correction for patients with a larger preoperative velopharyngeal gap.