title: Velopharyngeal insufficiency treated with levator muscle repositioning and unilateral myomucosal buccinator flap.
abstract: OBJECTIVE
  Velopharyngeal insufficiency (VPI) is common (20-30%) after cleft palate closure. The myomucosal buccinator flap has become an important treatment option for velopharyngeal insufficiency; however, published studies all use bilateral buccinator flaps. This study assesses outcomes with a unilateral myomucosal buccinator flap that might result in less operating time and might prevent the need of a bite block and an extra procedure for division of the flap pedicle at a later stage.
  
  
  METHODS
  Forty-two consecutive patients who underwent a unilateral myomucosal buccinator flap procedure were retrospectively reviewed. Overall clinical judgment of speech, speech analysis, and velopharyngeal closure were evaluated by a multidisciplinary cleft palate team.
  
  
  RESULTS
  Median follow-up was 1.2 years. In 83% of patients, overall clinical judgment of optimal speech was obtained and thus no further velopharyngeal surgery was necessary. In 7 patients, further surgery was necessary, of whom 57% (4/7) had bilateral cleft lip-palate. Mean level of intelligibility improved significantly as evaluated by speech pathologists (2.5 ± 0.9 vs 3.5 ± 0.9; P < 0.0001) and by parents (2.1 ± 0.9 vs 3.2 ± 0.7; P < 0.0001). Mean level of resonance improved significantly (0.7 ± 0.9 vs 2.0 ± 1.0; P < 0.0001), and velopharyngeal closure improved in 83% postoperatively.
  
  
  CONCLUSIONS
  The unilateral myomucosal buccinator flap seems to be an effective and safe procedure and should become part of the armamentarium of cleft surgeons.
authors.affiliation: Division of Pediatric Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands. Electronic address: r.j.h.logjes@gmail.com.
authors.forename: Robrecht J H
authors.initials: RJ
authors.lastname: Logjes
authors.affiliation: Division of Ear-Nose and Throat Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Maaike T A
authors.initials: MT
authors.lastname: van den Aardweg
authors.affiliation: Division of Pediatric Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Meike M J
authors.initials: MM
authors.lastname: Blezer
authors.affiliation: Speech Pathology, Division of Pediatric Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, The Netherlands.
authors.forename: Anne M B
authors.initials: AM
authors.lastname: van der Heul
authors.affiliation: Division of Pediatric Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Corstiaan C
authors.initials: CC
authors.lastname: Breugem
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery; D005152:Facial Muscles / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009061:Mouth Mucosa / Q000601:surgery*; D012189:Retrospective Studies; D013065:Speech Intelligibility; D013068:Speech Production Measurement; D013524:Surgical Flaps / Q000601:surgery; D014681:Velopharyngeal Insufficiency / Q000601:surgery
keywords: Buccal flap; Buccinator flap; Cleft surgery; Speech surgery; Velopharyngeal insufficiency; Velopharyngeal surgery