Assessment of Bilateral Buccinator Myomucosal Flaps in Management of Velopharyngeal Insufficiency in Patients with Cleft Palate

Abstract

We conducted a study for different methods of assessment of double BMF for palatal lengthening in the treatment of VPI in cleft palate and lip patients who had undergone previous primary palatal repair. All Flaps were transposed successfully without any complications or flap loss. Pedicle division was done 3 weeks later as a second stage procedure. Preoperative and 9 months postoperative VPI assessment were done by PSA (Perceptual speech assessment), nasopharyngoscopy and lateral cephalograms. In addition, intraoperative, clinical immediate and delayed assessment was done. All of patients had complete preservation of oral commissure symmetry and restoration of the normal functions of the donor site area without interference with chewing or oral hygiene, all patients had excellent cosmetic outcome. No flap loss or major complications occurred. We reported about 80% improvement in VPI and overall speech parameters that was in agreement with previous literature. PSA and nasoendoscopy are predictable methods of assessment of speech for evaluation of VPI. Cephalometric radiographs as a method of assessment of the velopharyngeal anatomy has the difficulty to be used with children as it`s difficult for the child to do sustained phonation during the exposure period of the cephlometric radiograph which lead to imprecise radiograph. Speech therapy following BMF operation should be continued for better and more rapid improvements. Our study proves that BMF procedure is a safe, easy, effective and dependable local sensate flap with a well‑defined neurovascular pedicle that can be used to manage VPI. It allows