Surgical Outcomes of Submucous Cleft Palate Using Intravelar Veloplasty with a Buccinator Musculomucosal Flap: A Case...

ObjectiveInvestigate the pre- and postoperative changes in patients with submucous cleft palate (SMCP) treated by intravelar veloplasty (IVV) with a buccinator musculomucosal flap (BMMF).DesignRetrospective case series.SettingTertiary, cleft team.Patients/ParticipantsChildren with SMCP who underwent IVV with a BMMF at Nagano Children's Hospital.Interventions: IVV with a BMMF between December 2018 and January 2022.Main outcome measuresPerceptual Japanese speech evaluation (hypernasality [HN], nasal emission, and intelligibility [IN]), amount of velopharyngeal (VP) gap, degree of soft palate elevation, amount of soft palate lengthening, VP closure pattern, additional surgery, and postoperative complications.ResultsEleven patients (four syndromic) were analyzed pre- and almost of 1 year postoperatively. Preoperative mean HN and IN scores were significantly improved (P = .0232 and P = .0313, respectively). VP gap was closed after surgery in most cases with initial VP gap <4.5 mm and good soft palate elevation. Mean soft palate lengthening with the BMMF method was 3.9 ± 1.2 mm, which was a significant increase (P = .00589). Four patients required additional surgery. We encountered no severe postoperative complications or fistula formation.ConclusionsIVV with a BMMF is considered applicable in patients with VP gap of up to 4.0 to 4.5 mm and good soft palate elevation. Our technique appears safe, with low risks of severe postoperative complications and fistula formation. Due to the limited cohort size, more cases are needed to elucidate the precise indications for the BMMF method.