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Use of Buccal Myomucosal Flap in Secondary Cleft Palate Repair

Robertson, Andrew G.N. M.S.; McKeown, Darren J. M.S.; Bello-Rojas, Gustavo M.D.; Chang, Yeon-Jeen M.D.; Rogers, Amy M.S.A., M.A.; Beal, Barbara J. B.S., R.N., C.P.S.N.; Blake, Mark M.D.; Jackson, Ian T. M.D., D.Sc.(Hon.)

Plastic and Reconstructive Surgery: September 2008 - Volume 122 - Issue 3 - p 910-917
doi: 10.1097/PRS.0b013e318182368e
Pediatric/Craniofacial: Follow-Up

Background: The purpose of this study was to assess the effectiveness of the buccal myomucosal flap in secondary repairs of cleft palate.

Methods: Twenty-two patients who underwent secondary palatoplasty between 1989 and 2004 in which a buccal myomucosal flap was used were reviewed retrospectively. All patients had undergone at least one previous attempted repair at other institutions. Indications for the secondary repair included velopharyngeal incompetence and/or oronasal fistula. Patients were evaluated preoperatively for oronasal fistula status, velopharyngeal competence, nasal resonance, speech quality, and nasal escape.

Results: The buccal myomucosal flap was used in all patients. The patients' mean age was 8.5 years (range, 1 to 23 years). Correction was indicated in seven patients with velopharyngeal incompetence (32 percent), five patients with oronasal fistulas (23 percent), and 10 patients with both conditions (45 percent). Preoperative assessment revealed four patients (18 percent) with an associated syndrome, 17 of 20 patients with hyperresonance (85 percent), 16 of 20 patients with nasal escape (80 percent), and 12 of 20 patients with poor speech (60 percent). The buccal myomucosal flap technique was used alone in 50 percent of patients, six patients had a staged correction (27 percent) and five patients required multiple procedures (23 percent). All fistulas remained closed. Two patients showed mild velopharyngeal incompetence (p = 0.001) and two patients continued to display hyperresonance (p < 0.001). Speech quality improved to a good level in 17 patients (77 percent) (p < 0.001).

Conclusion: Palate re-repair combined with a buccal myomucosal flap, occasionally in conjunction with other techniques, is an effective method for correcting failed cleft palate repairs.

Glasgow, Scotland, United Kingdom; and Southfield, Mich.

From the University of Glasgow and the Institute of Craniofacial and Reconstructive Surgery, Fisher Center.

Received for publication September 20, 2005; accepted June 9, 2006.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Ian T. Jackson, M.D., D.Sc.(Hon.), Craniofacial Institute, 16001 West Nine Mile Road, Third Floor Fisher Center, Southfield, Mich. 48075

©2008American Society of Plastic Surgeons