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The double-opposing buccal flap procedure for palatal lengthening
Robert J Mann1, Keith C Neaman, Shannon D Armstrong
1Grand Rapids, Mich. From Grand Rapids Medical Education Partners/Michigan State University Plastic Surgery Residency; the Division of Plastic Surgery, Helen DeVos Children's Hospital; and Michigan State University College of Human Medicine.
The double-opposing buccal flap effectively lengthens the palate, significantly improving speech intelligibility and resonance in patients with velopharyngeal dysfunction. This technique also reduces the risk of sleep apnea, offering a safe alternative for treatment.
Area of Science:
- Plastic Surgery
- Speech Pathology
- Otolaryngology
Background:
- Traditional treatments for velopharyngeal dysfunction, such as pharyngeal flaps and sphincteroplasty, have limitations.
- These limitations include potential complications like sleep apnea and disrupted nasal airflow.
Purpose of the Study:
- To evaluate the efficacy of the double-opposing buccal flap for palatal lengthening.
- To assess speech outcomes and complications associated with this surgical technique.
Main Methods:
- Retrospective review of 27 patients undergoing double-opposing buccal flap surgery (1994-2007).
- Patients had varying degrees of velopharyngeal dysfunction with some velar movement.
- Preoperative and postoperative speech assessments were compared.
Main Results:
- Significant improvements in intelligibility (65.4% to 95.5%) and resonance (hypernasal to normal).
- Only one patient required an additional pharyngeal flap; no sleep apnea complications occurred.
- Two cases of distal flap necrosis were noted.
Conclusions:
- The double-opposing buccal flap is effective for palatal lengthening and improving speech in velopharyngeal dysfunction.
- It is particularly beneficial for patients with intact velar movement and small to moderate velar gaps.
- This technique offers a reduced risk of sleep apnea compared to other methods.
