title: Buccinator flap as a method for palatal fistula and VPI management.
abstract: BACKGROUND
  Secondary palatal fistula and velopharyngeal insufficiency (VPI) are two major complications of palatoplasty. Various methods have been introduced for surgical repair of these complications; however, most of them are associated with a high recurrence rate and morbidity. This study was designed to evaluate the use of the buccinator myomucosal flap in the reconstruction of palatal fistula and velopharyngeal insufficiency following primary palatoplasty.
  
  
  METHODS
  This study was performed on 25 patients who had either secondary palatal fistula or velopharyngeal insufficiency. Their defects were repaired by buccinator myomucosal flaps (BMFs). Patients were followed for 8 weeks and follow-up visits were arranged at 1, 2, 4, and 8 weeks after discharge.
  
  
  RESULTS
  All BMFs were harvested and transposed successfully. The length of the soft palate increased 15.14 ± 1.13 mm postoperatively. One patient (4%) had flap dehiscence 6 days after the operation with no flap ischemia or necrosis. Another patient (4%) experienced recurrence of the palatal fistula with marginal necrosis of the BMF 6 weeks after the operation. Otherwise, no case of fistula recurrence, infection, flap ischemia or necrosis and donor-site morbidity was observed during follow-up sessions.
  
  
  CONCLUSIONS
  This study demonstrated that using BMFs could be a safe, effective and promising method of treatment for post palatoplasty fistula and VPI. However, further investigations on a larger sample size with longer follow-up are recommended for more accurate conclusion.
authors: Department of General and Plastic Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Hosein
authors: H
authors: Abdaly
authors: Department of General and Plastic Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mahmood
authors: M
authors: Omranyfard
authors: Department of General and Plastic Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mehdy Rasty
authors: MR
authors: Ardekany
authors: Department of General and Plastic Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Kamran
authors: K
authors: Babaei
keywords: Buccinator myomucosal flap; cleft palate; palatal fistula; velopharyngeal insufficiency