Effectiveness of secondary furlow palatoplasty with buccal myomucosal flap in correction of velopharyngeal insufficiency in patients with cleft palate

Abstract

Objectives: The main purpose of this study was evaluation of the effectiveness of secondary furlow palatoplasty with buccal myomucosal flap (FPBF) for the treatment of velopharyngeal insufficiency (VPI) in patients with a cleft palate who were treated with two flap palatoplasty (TFP) in their primary palate repair.

Material and methods: Twenty-three medically free children aged 4-8 years with non-syndromic and previously repaired cleft palate via TFP participated in the study. All patients received secondary surgery following the technique of FPBF. Preoperative speech evaluation was done before the secondary repair and 3 months after the surgery using a hypernasal speech scale, speech intelligibility scale, and nasopharyngoscopy.

Results: A statistically significant improvement was observed regarding the degree of hypernasality and speech intelligibility while comparing the preoperative scores after the primary surgery to the postoperative scores after the secondary surgery. In addition, a statistically significant improvement was found in the nasopharyngoscopic assessment.

Conclusions: The incorporation of a buccal myomucosal flap with Furlow palatoplasty was successful in improving hypernasality, speech intelligibility, and nasopharyngoscopic scores in patients with cleft palate.

Trial registration: clinicaltrials.gov (NCT05626933).

Clinical relevance: This technique might be the surgical technique of choice while treating patients who are suffering from VPI after cleft palate repair.

Keywords: Cleft palate; Furlow with buccal myomucosal flap palatoplasty; Two flap palatoplasty; Velopharyngeal insufficiency.

Fig. 1

The surgical procedures of a secondary FPBF. a: pre-operative view of a short repaired palate. b: oral and nasal Z-plasty incision. c: showed the BMMF incision. d: postoperative view of the oral side residual defect closure by BMMF

Fig. 2

Showing pre- and post-surgical nasopharyngoscopic assessment during the speech. a: pre-surgical velopharyngeal port during speech (incomplete closure). b: post-surgical velopharyngeal port during speech (complete closure)