Single-stage Palatal Lengthening Using Modified Buccinator Myomucosal and Buccal Fat Flaps

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Speech Pathology

Background:

• Surgical correction of velopharyngeal insufficiency (VPI) after cleft palate repair presents challenges.
• Conventional methods can improve speech but may cause airway obstruction due to pharyngeal narrowing.
• The buccinator myomucosal flap offers an alternative for VPI correction by restoring palate length and velar function.

Purpose of the Study:

• To present innovative modifications to the buccinator myomucosal flap procedure for VPI.
• To evaluate the efficacy of a single-stage procedure with enhanced flap design for VPI treatment.

Main Methods:

• Modified buccinator myomucosal flap technique performed in a single stage.
• Inclusion of full-thickness buccinator muscle and bilateral buccal fat flaps.
• Elimination of a mucosal bridge and avoidance of secondary pedicle division surgery.

Main Results:

• The modified technique facilitates tension-free wound closure.
• Improved flap vascularization and prevention of scar contracture through interposed buccal fat flaps.
• Successful VPI correction without the need for a second surgical intervention for pedicle division.

Conclusions:

• These surgical refinements provide a robust, single-stage solution for VPI.
• The modified buccinator myomucosal flap enhances healing and functional outcomes in cleft care.
• This approach minimizes complications associated with traditional VPI surgical treatments.