Bilateral buccinator myomucosal flap outcomes in nonsyndromic patients with repaired cleft palate and velopharyngeal insufficiency.

BACKGROUND: The purpose of this study was to assess speech outcomes and complication rate in nonsyndromic repaired cleft palate patients undergoing bilateral buccinator myomucosal flaps for velopharyngeal insufficiency management.

METHODS: A prospective study of consecutive repaired cleft palate patients with velopharyngeal insufficiency who underwent bilateral buccinator myomucosal flaps was conducted. Three experienced evaluators performed a blinded perceptual speech evaluation (hypernasality, audible nasal emission, and intraoral pressure). Successful speech outcome was defined as normal or borderline sufficient velopharyngeal function at 15 months postoperatively. Obstructive sleep apnea screening tools were applied preoperatively and postoperatively. Complication rate was also collected.

RESULTS: Fifty-three patients were included. There were 11 (21%) surgical complications, with no complete flap loss, snoring, sleep disturbance, and/or mouth breathing. All patients presented low pre- and postoperative risk for obstructive sleep apnea. At 15 months postoperatively, hypernasality (0.4 ± 0.6), audible nasal emissions (0.2 ± 0.4), and intraoral pressure (0.1 ± 0.3) were significantly (all p < 0.05) lower than preoperative measurements (hypernasality: 2.7 ± 0.5; audible nasal emissions: 2.2 ± 0.8; and intraoral pressure: 0.9 ± 0.3). Forty-five (85%) patients presented successful speech outcome.

CONCLUSION: The bilateral buccinator myomucosal flap is an effective and safe surgical strategy for the management of persistent velopharyngeal insufficiency.