BACKGROUND: Primary palatoplasties using the Anatomic Palate Restoration Concept use the buccinator myomucosal flap (buccal flap) to correct the tissue deficiency within the cleft palate malformation. Buccal flaps are used to replace the missing tensor veli palatini aponeurosis and mucus membrane. The surgical approach aims to close the palate without tension, lengthen the palate, reconstruct the levator muscular sling, not inhibit craniofacial growth and achieve proper oral-nasal resonance for speech.1,2 To the best of our knowledge, this is the first study to use magnetic resonance imaging (MRI) to demonstrate the changes that occur to the velopharyngeal anatomy following the surgical repair. The purpose of this study is to present preliminary data on velopharyngeal variables to demonstrate the muscle and tissue morphology in adults with cleft palate who have not received a secondary surgery for speech or orthognathic surgery. METHODS: MRI was used to analyze velopharyngeal variables for a single participant. The participant was a 19-year-old Caucasian male with a unilateral cleft lip and palate who received primary palatoplasty using the buccal flap approach. MRI data were viewed in Amira 6.5.0 Visualization Modeling software. Velopharyngeal measurements were obtained on the midsagittal image. RESULTS: All variables were compared to previously published normative data of velopharyngeal variables for individuals with noncleft anatomy who are of the same race, sex, and of similar age.3 Velar length and velar thickness were both greater in the individuals with the buccal flap repair, in comparison to the individuals with noncleft anatomy. Levator length and the distance from the PNS to PPW were both shorter in the individual with the buccal flap repair. Visually, the individual with the buccal flap presents with a thicker and longer velum. CONCLUSIONS: This study is the first to demonstrate the velopharyngeal muscle and tissue arrangement following primary palatoplasty using the buccal flap approach. The individual presents with a longer and thicker velum in comparison to age- and sex-matched individuals with noncleft anatomy. This study highlights the utility of using MRI to quantify the changes that occur to the velopharyngeal anatomy following the buccal flap surgical approach. Future studies should assess how these anatomical changes impact speech and compare data to Z-Plasty without the use of the buccal flap repair and to individuals with noncleft anatomy. Our research team is currently investigating this line of research and specifically seeking to improve our understanding of the functional impact of this surgical method on speech. REFERENCES: 1. Mann RJ, Fisher DM. Bilateral buccal flaps with double opposing Z-plasty for wider palatal clefts. Plast Reconstr Surg. 1997;100:1139–1143. 2. Mann RJ, Martin MD, Eichhorn MG, et al. The double-opposing Z-plasty plus or minus buccal flap approach for repair of cleft palate: a review of 505 consecutive cases. Plast Reconstr Surg. 2017;139:735e–744e. 3. Perry JL, Kollara L, Sutton BP, et al. Growth effects on velopharyngeal anatomy from childhood to adulthood. J Speech Lang Hear Res. 2019;62:682–692.