title: Buccinator sandwich pushback: a new technique for treatment of secondary velopharyngeal incompetence.
abstract: OBJECTIVE
  A small percentage of patients have inadequate velopharyngeal closure, or secondary velopharyngeal incompetence, following primary palatoplasty. Use of the buccinator musculomucosal flap has been described for primary palate repair with lengthening, but its use in secondary palate lengthening for the correction of insufficient velopharyngeal closure has not been described. This study presents the results of a series of patients who had correction of secondary velopharyngeal incompetence using bilateral buccinator musculomucosal flaps used as a sandwich.
  
  
  METHODS
  In this prospective study between 1995 and 1998, a group of 16 patients with insufficient velopharyngeal closure as determined by speech assessment and videoradiography were selected. Nasopharyngoscopy was carried out in addition in a number of cases. Case selection was a result of these investigations and clinical examination in which the major factor in velopharyngeal insufficiency was determined to be short palatal length.
  
  
  METHODS
  The patients underwent palate lengthening using bilateral buccinator musculomucosal flaps as a sandwich. All patients were assessed 6 months postoperatively. The operative technique, postoperative course, and recorded postoperative complications including partial/total flap necrosis and residual velopharyngeal insufficiency were evaluated. Preoperative and postoperative speech samples were rated by an independent speech therapist.
  
  
  RESULTS
  Ninety-three percent (15 of 16) had a significant improvement in velopharyngeal insufficiency, and 14 patients had no hypernasality postoperatively. Both cases of persistent mild hypernasality had had a recognized postoperative complication.
  
  
  CONCLUSIONS
  The sandwich pushback technique for the correction of persistent velopharyngeal incompetence was successful in achieving good speech results.
authors.affiliation: Northern Ireland Plastic and Maxillofacial Service, The Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland. crhill@btinternet.com
authors.forename: C
authors.initials: C
authors.lastname: Hill
authors.forename: C
authors.initials: C
authors.lastname: Hayden
authors.forename: M
authors.initials: M
authors.lastname: Riaz
authors.forename: A G
authors.initials: AG
authors.lastname: Leonard
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery; D005152:Facial Muscles / Q000637:transplantation*; D006801:Humans; D009061:Mouth Mucosa / Q000601:surgery; D019647:Oral Surgical Procedures / Q000379:methods*; D010160:Palate, Soft / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D013524:Surgical Flaps; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000601:surgery*; D014832:Voice Disorders / Q000209:etiology / Q000601:surgery