The buccal flap--a useful technique in cleft palate repair?
OBJECTIVE
To evaluate speech quality and oronasal fistula after primary palate repair using a buccal mucosal flap.


METHODS
Retrospective study cohort of patients with cleft palate.


METHODS
Primary care center for treatment of craniofacial congenital anomalies.


METHODS
One hundred fifty-six nonsyndromic patients underwent palatoplasty with the buccal myomucosal flap by the senior surgeon between 1989 and 2002. The preoperative workup, surgical technique, and other factors that might affect the outcome were identical in every case. Oronasal fistula and variables affecting speech quality were analyzed.


RESULTS
The most common type of cleft was unilateral cleft lip and palate (43.5%). The median follow-up was 5.8 years (0.4 to 21 years), and the median age at repair was 6.2 months. The overall fistula formation was 3.6%, decreasing progressively: 1989 to 1994: 2.9%, 1995 to 2002: 0.7% (p <.05). Velopharyngeal incompetence (VPI) occurred in 8.8% of the patients, decreasing from 5.3% to 3.5% in the last years. VPI and oronasal fistulae were observed mainly in unilateral and bilateral clefts of the lip and palate. Velopharyngeal adequacy occurred in 91.1% of the children, and resonance was normal in 91.1 %. None of the patients had severe hypernasality or hyponasality. Articulation was normal in 97.9% of the children. Speech quality was good in 89% of the patients.


CONCLUSIONS
The technique presented has been effective, with the advantages of palatal closure without tension, good muscular reconstruction, lengthening of the nasal layer, and palatal closure without raw areas. The technique, early repair, and surgeon's skills were the most important variables for good outcomes regarding speech and fistula formation.
Cleft Diagnostic Clinic, Institute for Craniofacial and Reconstructive Surgery, Southfield, Michigan, USA. ianjackson@juno.com
Ian T
IT
Jackson
Andrea A
AA
Moreira-Gonzalez
Amy
A
Rogers
Barbara J
BJ
Beal
D001184:Articulation Disorders / Q000517:prevention & control; D002610:Cheek; D002971:Cleft Lip / Q000601:surgery; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation; D009668:Nose Diseases / Q000517:prevention & control; D016155:Oral Fistula / Q000517:prevention & control; D019647:Oral Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013062:Speech Articulation Tests; D013068:Speech Production Measurement; D013524:Surgical Flaps; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000517:prevention & control; D014832:Voice Disorders / Q000517:prevention & control