Abstract
IntroductionThe interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up.ObjectiveTo evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency.MethodsPatients with repaired cleft palate (± lip) who were submitted to surgical correction of velopharyngeal insufficiency using the bilateral buccinator myomucosal flap were assessed. Hypernasality (scores 0 [absent], 1 [mild], 2 [moderate], or 3 [severe]) was analyzed by three evaluators by measuring the audiovisual records collected in early and late preoperative and postoperative periods (3 and 12 months, respectively). The values were considered significant for a 95% Confidence Interval (p < 0.05).ResultsThirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Analyses of the late postoperative period showed that hypernasality (0.5 ± 0.7) was significantly (p < 0.05) lower than the hypernasality of the preoperative and recent postoperative periods (2.8 ± 0.4 and 1.7 ± 0.9, respectively).ConclusionThe buccinator myomucosal flap is effective in reducing/eliminating hypernasality in patients with cleft palate (± lip) and velopharyngeal insufficiency.
Highlights
The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up
5---36% of patients with cleft lip and palate submitted to primary palatoplasty have post-operative velopharyngeal insufficiency, a structural defect characterized by the inability to attain complete closure of the velopharyngeal sphincter due to mechanical restriction, inappropriate positioning and/or tissue insufficiency.[1,2]
The objective of this study was to evaluate the effect of bilateral buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate (±lip) and velopharyngeal insufficiency. This is a prospective study of all patients with cleft palate ± lip consecutively submitted to bilateral buccinator myomucosal flap for the treatment of velopharyngeal insufficiency between January 2010 and January 2014 by a single surgeon
Summary
The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up. Objective: To evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency. Results: Thirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Satisfactory speech results have been described with such surgical interventions,3---10 some factors (e.g., types of previously performed palatine surgeries, presence of scarring on the palate, and medium or large velopharyngeal gap) limit the applicability of double reverse z-plasty or intravelar veloplasty to a small number of patients.3,6---10
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