Intravelar Veloplasty Research Articles

Exploring the Relationship Between Palatal Cleft Type and Width With the Use of Relieving Incisions in Primary Repair.

The mainstay of palatal repair in the United Kingdom is the intravelar veloplasty (IVVP). It is not always possible to align the oral mucosa in the midline to achieve tension-free repair. The addition of lateral relieving incisions may aid transposition of the oral mucosa to allow closure. The aim of this study was to explore cleft features that may predispose to a requirement for relieving incisions in order to allow palate closure. We performed a national multiinstitutional retrospective study using data from the UK Cleft Collective cohort study. The study sample consisted of 474 patients who had undergone IVVP at the time of palatal closure across all 16 of the UK cleft units. We found strong evidence for the requirement for relieving incisions in patients with an increased degree of clefting per the Veau classification (P < .001), increasing palatal soft-edge width (P < .001) and moderate evidence of an associated use in patients with Pierre Robin sequence (P = .015). Insufficient data were available to explore the relationship between intertuberosity distance and the presence of fistula formation with the use of relieving incisions. The results of this study identify cleft features that increase the likelihood for requiring lateral relieving incisions to allow palatal closure. The degree to which the addition of relieving incisions to IVVP affects maxillary growth and speech outcomes is unknown. Further study is required to answer this important question.

Surgical management in submucous cleft palate patients

ObjectivesThe submucous cleft palate (SMCP) is considered to be the most subtle type of cleft palate. Early detection is important to allow on time intervention by speech therapy and/or surgical repair before the children already develop compensatory speech mechanisms. The purpose of this study was to investigate at what time children with a SMCP present, to determine when children are operated, and to analyze the postoperative outcomes for in SMCP children.Patient and methodsMedical records from 766 individuals registered in the cleft registry in the Wilhelmina’s Children’s’ Hospital, Utrecht, were retrospectively reviewed. Inclusion criteria were children diagnosed with SMCP. The following data were collected: age at diagnosis, physical examination, age at surgery, surgical technique, speech therapy pre- and post-surgery, otitis media, secondary cleft surgery, family history, syndromes, and other anomalies.ResultsIn total, 56 SMCP children were identified. The mean age of diagnosis was 44.0 months (range 0–150, SD = 37.0). In 48 children (85.7%), surgical intervention was performed (Furlow plasty, intravelar veloplasty, pharyngoplasty, or Furlow combined with buccal flap).ConclusionThis retrospective study reconfirms that SMCP often presents late, even in a country with a modern healthcare system and adequate follow-up of all newborns by the so-called youth doctors in “children’s healthcare centers” up to the age of 4 years old. Almost 86% of patients ultimately needed palate surgery when SMCP was suspected.Clinical relevanceAny child presenting with repeated episodes of otitis media, nasal regurgitation, or speech difficulties should have prompt consideration for SMCP as diagnosis.

Surgical Variation Between Consultant Surgeons Performing a Sommerlad Radical Intravelar Veloplasty.

Although cleft surgeons in the United Kingdom follow a similar training pathway, and cleft centers adhere to similar protocols regarding timing of palate surgery and surgical technique, speech outcomes still vary significantly between centers. To explore if differences in technique exist between individual surgeons, performing a Sommerlad radical intravelar veloplasty (IVVP). An exploratory, qualitative approach was adopted to understand the views of UK cleft surgeons performing a Sommerlad radical IVVP for primary cleft palate repair and to discuss what was important in the adoption, adaptation, and evolution of this technique within their own practice. A semistructured interview schedule was designed. Interviews were conducted in person or via videoconferencing, with interested surgeons. The interviews were recorded, transcribed, and checked for accuracy. Analysis involved inductive thematic analysis. Fourteen cleft consultants from the United Kingdom participated (3 females and 11 males). Seven of the consultants were trained in plastic surgery and 4 in oral and maxillofacial surgery. Eight themes were identified from the thematic analysis. One theme-Surgical Variation-is discussed. The findings provide insight into areas of variation seen within one surgical technique of cleft palate repair. These variations may have arisen to accommodate heterogeneity in the patient population or may have evolved in relation to different experiences of training or influences of colleagues. Further work is needed to explore the reasons for these differences in technique and to identify if any of these subtle differences contributed to variability in outcomes.

Comparison of speech outcomes using type 2b intravelar veloplasty or furlow double-opposing Z plasty for soft palate repair of patients with unilateral cleft lip and palate

BackgroundThe aim of this study is to compare speech outcomes, fistula rates, and rates of secondary speech surgeries after palatoplasty using Furlow palatoplasty or type 2b intravelar veloplasty for soft palate repair. Patients and methodsPatients with unilateral cleft lip and palate who had either Furlow palatoplasty or intravelar veloplasty for soft palate repair were retrospectively evaluated for demographic and perioperative variables and speech outcomes. Fistula rate, secondary surgical intervention for improved speech results, and findings of speech assessment were further reviewed for the patients who met the inclusion criteria. ResultsA total of 76 patients, 36 in the Furlow palatoplasty group and 40 in the intravelar veloplasty group, were included in the study. In the speech assessment, nasalance values were statistically similar between the two groups. Also, there was no statistically significant difference between the groups in velopharyngeal motility (p = 0.103). The total rates of secondary surgeries and fistula were statistically similar between the groups (p = 0.347 and 0.105, respectively). ConclusionThe similar outcomes of speech and surgical evaluation between the two groups make the surgeon's preference determinant in the selection of the surgical technique for soft palate repair.

Long-term Speech Outcomes of Cleft Palate Repair in Robin Sequence versus Isolated Cleft Palate.

This retrospective case series of consecutive syndromic and isolated RS- and ICP-patients (1990-2016) includes indications and outcomes of straight-line repair with intravelar veloplasty (SLIV) or Furlow repair depending on cleft and airway characteristics. Seventy-five RS and 83 ICP patients underwent CP repair. Velopharyngeal insufficiency (VPI) occurred in 41% of RS versus 17% of ICP patients (P = 0.012), and in 60% of patients with syndromic RS versus 16% with isolated RS (P = 0.005). In multivariable logistic regression analysis, wider and more severe CP anatomy was the only factor independently associated with VPI (P = 0.028), in contrast to age at repair, syndromic RS compared with isolated RS, and isolated RS compared with ICP and initial tongue-lip adhesion. Secondary Furlow after primary SLIV was used to treat VPI in all groups, and more frequently in syndromic versus isolated RS patients (P = 0.025). Variability of RS anatomy and airway compromise necessitates individualized treatment protocols. Despite differing CP etiology and other variables, our findings demonstrate cleft anatomy as the only independent variable predictive of VPI comparing RS and ICP patients. Patients with isolated RS should ultimately attain similar VPI outcomes compared with ICP patients. Obstructive speech operations in RS patients can be avoided without compromising speech outcome by reserving the prsocedure for secondary cases.

Treatment of velopharingeal insuffitiency with turn over mucoperiosteal palatinal flap in a patient with DiGeorge syndrome

Introduction. DiGeorge syndrome (velocardiofacial syndrome) occurs in about 1 in 4,000 people. It is characterized by incomplete gene penetration, due to which there is significant variability in the clinical picture in different patients. The paper describes the successful application of an inverted mucoperiosteal flap of the palate in a nine-year-old girl with DiGeorge syndrome who had pronounced velopharyngeal insufficiency (VPI). Case report. The girl was the first-born child from a normal pregnancy and a normal birth with a normal early psychomotor development. During breastfeeding, milk was occasionally returned to the nose, and later deviations from normal speech (incomprehensible and nasal speech) were noticed. At the age of 4, detailed genetic testing was performed and a microdeletion of 22q11 chromosome was found. Also, a submucosal cleft palate was established, and magnetic resonance angiography of the head and neck revealed an abnormal position of the left internal carotid artery (ICA) that extended submucosally to the central axis of the posterior wall of the pharynx. Then, the submucosal cleft palate was surgically resolved in other clinical center, but without speech improvement. Pharyngoplasty was not performed due to the risk of serious post-operative complications. It was explained to the parents that speech recovery will not be satisfactory without surgical treatment of VPI. At the age of 9, the girl was admitted to the Clinic for Plastic and Reconstructive Surgery and Burns of the Military Medical Academy in Belgrade for surgical treatment of VPI. Taking into account the potential risks of certain surgical methods, it was decided to perform intravelar veloplasty according to Furlow. Since it was intraoperatively found that the soft palate is too short and that this procedure cannot provide its sufficient length, the mucoperiosteal flap was lifted from the palate to the palatal aponeuroses on the posterior edges of the palatine bones leaving their oral surfaces exposed. The mucoperiosteal flap raised in this way could not also provide the required length of the soft palate only by retroposition. However, its length is 160% of the soft palate axis length, which was enough to turn over the front of the flap towards the pharynx of the soft palate to reach its posterior wall. The raised mucoperiosteal palatal flap has no muscles, so its motility was achieved by the fact that along the edges of the existing short and mobile palate, the flap was fixed to the existing palate and uvula. This provided the anatomical preconditions for speech recovery, shown during the one-year post-operative follow-up of the child. Exposed palatine bones and short palate was covered by mucosal tissue, without cystic formations. Conclusion. The mucoperiosteal palatal flap can be easily, successfully and maximally safely applied in the resolution of VPI in patients with DiGeorge syndrome where there is an aberrant submucosal position of the ICA. This flap could be a ?flap of choice? for such patients with atopic position of the ISA, too.

In-Depth Survey of Demographic, Clinical, and Operative Measures in Cleft Lip and Palate Patients in Northwestern Turkey

Background: Orofacial clefts are the most common congenital craniofacial anomalies, globally. However, few reports describe cleft demographic, clinical, and surgical information in a Turkish population. Aims and Objectives: The aim of this study is to investigate the demographic, clinical, surgical information and outcomes of cleft lip and/or palate (CL/P) patients in Northwestern Turkey. Materials and Methods: We assessed demographic, clinical, operative characteristics, and postoperative complications data in this retrospective review of electronic medical records at a tertiary referral center from 2005 to 2015. Results: Our study included 150 CL/P patients (88 men, 62 women). Cleft lip and palate (CLP) was the most prevalent type of cleft (60%), followed by isolated cleft palate (31.3%) and isolated cleft lip (8.7%). The rates of maternal folic acid use, smoking, alcohol intake, and consanguinity were 83.3%, 5.3%, 1.3%, and 3.3%, respectively. Nasoalveolar molding was applied mostly in bilateral—not unilateral—CLP patients. The modified, extended Mohler technique was common for cleft lip repairs. Most cleft palate repairs used Bardach's two-flap palatoplasty combined with radical intravelar veloplasty. Most cases required grommet insertion. For cleft palate patients, myringotomy or paracentesis was performed in 12.8% of repairs, and acellular dermal matrix was used in 28.5% of repairs. Conclusion: Knowledge of CL/P characteristics is crucial for treatment planning and satisfactory health care. To our knowledge, this is the first study to assess CLP data in a Turkish population.

The buccal fat pad and intravelar veloplasty

Introduction: We describe the use of the buccal fat pad flap in conjunction with the Sommerlad method of cleft palate repair.

Customized Pre-Epiglottic Baton Plate-A Practical Guide for Successful, Patient-Specific, Noninvasive Treatment of Neonates With Robin Sequence.

Objective:Despite its efficiency and benefits in treating patients with Robin sequence (RS), the pre-epiglottic baton plate (PEBP) is not widely used. However, its acceptance might improve with specific defined parameters for indication and proper design of the velar extension. We present our 13-year, single-center experience in treating infants with RS using PEBP, focusing on the description and insertion of an endoscopically guided PEBP design along with its complications and limitations.Design and Innovation:We recommend PEBP as primary treatment for RS, suggesting a new approach of design adjustment based on endoscopic findings of multilevel upper airway obstruction.Setting:Department of cleft lip and palate.Patients:Infants with isolated or syndromic RS, period 2010 to 2019.Interventions:Pre-epiglottic baton plate treatment, intravelar veloplasty, and hard palate closure after initial PEBP treatment.Results:We treated 132 infants (isolated RS, 111; syndromic RS, 21) with PEBP. All infants with isolated RS were discharged within an average of 8 days of PEBP therapy. For them, no tracheotomy or tongue–lip adhesion procedures were needed. Only 4 of the 20 infants discharged with a nasogastric tube needed it for >2 weeks. Intravelar veloplasty and palate closure were performed after 3 and 6 months of initiating PEBP treatment, respectively.Conclusions:Application of an orthodontic device in RS therapy has not been accepted worldwide. We hope that our learning curve and recommendations about PEBP will help the implementation of this highly effective and nonsurgical treatment option.

Validating the Asher-McDade score to assess facial aesthetic outcomes in 22 consecutive complete bilateral cleft lip repairs

Most scoring systems used to assess facial aesthetics in cleft patients tend to lack consistency, and the absence of an internationally agreed system makes comparison challenging. The most widely used and validated tool is the five-point Asher-McDade index. We note that there are currently no reports (to our knowledge) of its use for scoring outcomes after bilateral cleft lip repair. To validate it for this use, the aim was to describe the outcomes of 22 consecutive bilateral cleft lip repairs assessed using this scale. A retrospective review was undertaken of 22 consecutive patients with bilateral cleft lip repairs performed at our centre. Each patient underwent bilateral advancement rotation repair with a vomer flap on one side at three months followed by repair of the remaining hard palate and an intravelar veloplasty three months later. Standardised photographs were taken five years after repair and were cropped to isolate the nasolabial component. Eleven members of the cleft multidisciplinary team were asked to rate each image on a five-point Likert scale. Statistical analysis was performed using a two-way ANOVA test and intraclass correlation coefficient to interrogate intraobserver and interobserver variance. A total of 22 consecutive patients with complete bilateral cleft lips were photographed. The overall mean (range) score for the repairs was 3.2 (4.3 - 1.8). Two-way ANOVA demonstrated that inter-rater variability accounted for just over 10% (11.23% of the total variance, p < 0.0001). As predicted, the single biggest factor affecting score variability was the patient’s appearance, which accounted for 44.51% of the total variance between scores (p < 0.0001). Intraobserver variance was not found to be significant, accounting for 0.33% of the total variance (p = 0.0006). We demonstrate that the Asher-McDade scoring system is a valid tool to use when assessing bilateral cleft lip repairs. Variance in the patient’s score was significantly related to a true difference in appearance, with only a small percentage of differences being due to intraobserver and interobserver variation.

Primary Palatoplasty With Intravelar Veloplasty Using Acellular Dermal Matrix Interpositional Graft.

The aim of this study was to analyze the effect of acellular dermal matrix (ADM) on fistula formation after primary palatoplasty using intravelar veloplasty for levator veli palatini muscle repair.This single-center retrospective study included patients who underwent primary palatoplasty with intravelar veloplasty for reorientation of the levator veli palatini muscles between April 2014 and March 2018. In the control group (group A) conventional intravelar veloplasty was performed, while in the ADM group (group B) intravelar veloplasty using ADM was performed. The study sample was composed of 162 patients, 81 in each of the 2 groups (A and B). In group B, securely dissected muscles were overlapped, and a pentagon-shaped ADM (AlloDerm, LifeCell Corp., Branchburg, NJ) of 1.6 mm mean thickness, 11.3 mm mean width, and 14.4 mm mean length was designed, and placed under the repaired levator muscle sling. The outcome variable was the occurrence of oronasal fistula within the first 6 months after surgery.Postoperative fistula formation was reported in 6 patients in group A (7.4%) and in 5 patients in group B (6.2%). There was no statistically significant difference between the 2 groups (P = 0.755). There were 7 cases of ADM exposure and 2 cases of wound dehiscence in group B.The results of this study demonstrated that ADM use did not have any disadvantage with respect to oronasal fistula complications after intravelar veloplasty for levator veli palatini muscle repair.

A comparative study of three palatoplasty techniques in wide cleft palates

The aim of this study was to clinically evaluate the effectiveness of various palatoplasty techniques for the repair of cleft palates greater than 8mm in width. This prospective cohort study included 142 patients with complete cleft palate between September 2017 and January 2019. Among the patients, 60 underwent a modified palatoplasty with Furlow Z-plasty (MPFZP), 51 underwent a von Langenbeck (VL) repair, and 31 underwent a two-flap palatoplasty (2FP). The MPFZP technique was modified with bilateral relaxing incisions and a radical intravelar veloplasty. Descriptive statistics and the χ2 test were used to explore and compare the rates of complications among the three surgical techniques. No statistically significant difference in sex, age at repair, cleft width, or cleft Veau type was found among the three groups. Rates of wound dehiscence at 1 week and fistula formation at 3 months after the surgery also did not differ significantly among the three techniques. However, velopharyngeal function for speech was better in patients who underwent MPFZP compared to the other two techniques (P<0.05). The repair of a wide cleft palate can be difficult due to the tension at closure. Although the study findings did not demonstrate a difference in complication rates among the three techniques, MPFZP appears to have the best functional outcomes in patients with a cleft palate wider than 8mm.

Using MRI and Nasopharyngeal Endoscopy for Assessment of Soft Palate Following Cleft Palate Surgical Repair Using Two Surgical Techniques

Purpose: to compare and assess the results obtained by using 2 different surgical techniques that utilize two stage palatoplasty to repair the palate, Furlow’s technique and intravelar veloplasty. Material and Methods: This study was performed on 14 patients suffering from cleft palate, patients were divided into 2 groups, in group I Furlow’s technique was used in palatal repair, in group II IVVP technique was used in palatal repair. All cases were selected from the Outpatient Clinic of the Faculty of Dental Medicine, Al-Azhar University for Girls. Results: Postoperative results of the MRI showed that the velum and the length of the muscle has become longer in each group, even though, there was no significant change between both techniques. The postoperative results of the nasopharyngeal endoscope proved that the increase in the levator muscle length increased the movement of the velum, in each group, however, between both group there was no significant difference. Conclusions: Both Furlow palatoplasty and intravelar veloplasty are efficient techniques that can be used in the repair of cleft soft palate. Both techniques can lengthen the soft palate together with palatal muscle reorientation; without the need to raise large mucoperiosteal flaps from the hard palate. Both techniques, with their modifications had shown success in the primary closure of different varieties and sizes of cleft gaps. The two stage palatoplasty can eliminate the need to raise large mucoperiosteal flaps from the hard palate.

Cleft Palate Surgery with Intravelar Veloplasty: A Case Report of Clinical and Speech Analysis with 5 Year Follow-up Result

Cleft Palate Surgery with Intravelar Veloplasty: A Case Report of Clinical and Speech Analysis with 5 Year Follow-up Result

Surgical management in a severe OSA patient diagnosed with Stickler syndrome

Stickler syndrome is a genetic disorder of connective tissue. One of the major symptoms associated with this disorder is an oro-facial malformation, which may cause a submucous cleft or a complete cleft of the hard palate. A 32-year-old man diagnosed with Stickler syndrome and a submucosal cleft palate (SMCP) visited our hospital with a chief complaint of excessive daytime sleepiness. The patient was diagnosed with severe obstructive sleep apnea (OSA), and administration of a polysomnography test revealed an apnea-hypopnea index (AHI) of 30.9 events/hour (h). Auto-titrating continuous positive airway pressure was initiated to control the OSA symptoms and subsequently the patient showed some improvement. However, due to continuous velopharyngeal insufficiency symptoms, intravelar veloplasty was performed. Three months after surgery, the AHI had decreased to 12.4 events/h. Recent studies have described a greater risk for OSA in individuals with cleft palate, than in the general population. The present case demonstrates surgical success in a patient with OSA and SMCP, suggesting that palatal surgery may be considered an optional surgical treatment for OSA patients with SMCP.

Optimizing speech outcomes for cleft palate.

Cleft lip with or without palate is one of the most common pediatric birth anomalies. Patients with cleft palate often have speech difficulties from underlying anatomical defects that can persist after surgery. This significantly impacts child development. There is a lack of evidence exploring, which surgical techniques optimize speech outcomes. The purpose of this update is to report on recent literature investigating how to optimize speech outcomes for cleft palate. The two-flap palatoplasty with intravelar veloplasty (IVVP) and Furlow double-opposing Z-plasty has the strongest evidence for optimizing speech. One-stage palatal repair is favored at 10-14 months of age, while delays are associated with significant speech deficits. For postoperative speech deficits, there is no significant difference between the pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation. Surgical management should be guided by closure pattern and velopharyngeal gap but few studies stratify by these characteristics. According to recent evidence, the two-flap palatoplasty with IVVP and Furlow palatoplasty result in the best speech. The pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation are all viable techniques to correct residual velopharyngeal insufficiency. Future research should focus on incorporating standardized measures and more robust study designs.

Speech outcome after intravelar veloplasty

ObjectiveCleft lip and palate is the main craniofacial malformation in France. Many surgical techniques had been described to restore cleft palate. In this study, we evaluate phonation in a homogeneous series of patient with isolated unilateral non-syndromic cleft lip and palate before (and after) alveolar cleft closure, operated according to our surgical protocol. MethodsWe included retrospectively 71 patients with isolated non-syndromic unilateral cleft lip and palate (UCLP), operated in our department from 2009 to 2013. All patients underwent the same surgical protocol: modified Millard cheilorhinoplasty (from 5 to 9-month-old); direct hard palatal closure (from 12 to 20-month-old); alveolar cleft closure with cancellous iliac bone graft (from 4 to 6-year-old). The phonation and clinical statute were evaluated before and after alveolar cleft closure. Fistula rate and speech evaluation were recorded. ResultsThe rate of oronasal fistula was 12.7%. About phonation, 76% and 86% of patients were competent or borderline competent respectively before and after gingivoperiostoplasty. ConclusionThis surgical protocol provided speech results in patients with isolated unilateral non-syndromic cleft lip and palate. The gingivoperiostoplasty improved the speech intelligibility.

Lessons from American Board of Plastic Surgery Maintenance of Certification Tracer Data: A 16-Year Review of Clinical Practice Patterns and Evidence-Based Medicine in Cleft Palate Repair.

As a component of the Maintenance of Certification process from 2003 to 2019, the American Board of Plastic Surgery tracked 20 common plastic surgery operations. By evaluating the data collected over 16 years, the authors are able to examine the practice patterns of pediatric/craniofacial surgeons in the United States. Cumulative tracer data for cleft palate repair was reviewed as of April of 2014 and September of 2019. Evidence-based medicine articles were reviewed. Results were tabulated in three categories: pearls, or topics that were covered in both the tracer data and evidence-based medicine articles; topics that were covered by evidence-based medicine articles but not collected in the tracer data; and topics that were covered in tracer data but not addressed in evidence-based medicine articles. Two thousand eight hundred fifty cases had been entered as of September of 2019. With respect to pearls, pushback, von Langenbeck, and Furlow repairs all declined in use, whereas intravelar veloplasty increased. For items not in the tracer, the quality of studies relating to analgesia is among the highest of all areas of study regarding cleft palate repair. In terms of variables collected by the tracer but not studied, in 2019, 41 percent of patients received more than 1 day of antibiotics. This article provides a review of cleft palate tracer data and summarizes the research in the field. Review of the tracer data enables cleft surgeons to compare their outcomes to national norms and provides an opportunity for them to consider modifications that may enhance their practice.

Analysis of the Intrinsic Predictors of Oronasal Fistula in Primary Cleft Palate Repair Using Intravelar Veloplasty.

The purpose of the present study was to investigate various factors of cleft palate and to analyze their effect on fistula occurrence following palatal muscle repair using intravelar veloplasty. A retrospective review of patients who underwent palatoplasty was performed. Primary palatoplasty was performed by a single surgeon in a single center. A total of 165 patients who underwent palatoplasty were enrolled. Primary palatoplasty with levator veli palatini muscle repair using intravelar veloplasty was performed. Three extrinsic factors (age, gender, and body weight) and 6 intrinsic factors (cleft width, ratio of cleft width to intermaxillary tuberosity distance, cleft anterior margin shape, uvula position, cleft lip, and radical intravelar veloplasty) were analyzed. Palatal fistula occurred in 11 (6.67%) patients. The occurrence of fistula was significantly correlated with a specific Veau classification, that is, type II (P = .041). Fistula tended to occur more frequently with a wide cleft palate (P = .063), and the high-risk cutoff value of the width was 7.75 mm. A larger cleft width tended to increase the occurrence of fistula. Close observation and information about the higher risk of fistula formation should be given to patients with a large cleft width who underwent intravelar veloplasty.

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

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. 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. Among 30 consecutive cases who had Bs + Re: IVVP, 24 had adequate pre- and postoperative records of speech outcome data. Multidisciplinary cleft team in a tertiary referral center. 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. 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.