The Effectiveness of the Buccal Myomucosal Flap on Speech and Surgical Outcomes in Cleft Palate: A Systematic Review
DOI:
https://doi.org/10.12970/2311-1917.2020.08.07Keywords:
Buccal flap, systematic review, perceptual speech assessment, speech outcomes, surgical outcomes.Abstract
Purpose: A systematic review was conducted to assess speech and velopharyngeal competence outcomes following the buccal myomucosal flap surgical approach used for primary palatoplasty and secondary surgery for velopharyngeal insufficiency (VPI) in individuals with cleft palate.
Methods: A systematic review was guided by the PRISMA guidelines. Articles were included if the patients received the surgical technique for primary cleft palate repair or secondary surgery for VPI and if the study provided detailed methods on the perceptual speech assessment or visualization of postoperative velopharyngeal anatomy.
Results: A total of 1013 patients were included from 11 studies. Post-surgery, normal resonance was achieved in 77.4% of patients and no nasal air emission was reported in 54.7% of patients. An improvement in velopharyngeal closure was reported in 81.8% of patients. A variety of perceptual speech assessment scales and methods for assessing velopharyngeal competence were used in the studies.
Conclusions: The review suggests that the buccal myomucosal flap procedure results in improved velopharyngeal closure as evidenced by physiologic observation and reported perceptual changes in speech intelligibility, resonance balance, and reduced nasal air emission. The development of an international, standardized method for assessing and reporting speech outcomes and velopharyngeal competency is recommended to ensure accurate comparisons between surgical techniques.
References
Mann RJ, Martin MD, Eichhorn MG, et al. The double opposing z-plasty plus or minus buccal flap approach for repair of cleft palate: A review of 505 consecutive cases. PlastReconstr Surg 2017; 139: 735e-744e. https://doi.org/10.1097/PRS.0000000000003127
Fisher DM, Sommerlad BC. Cleft lip, cleft palate, and velopharyngeal insufficiency. PlastReconstr Surg 2011; 128: 342e-360e. https://doi.org/10.1097/PRS.0b013e3182268e1b
Lithovious RH, Ylikontiola LP, Sándar GKB. Frequency of pharyngoplasty after primary repair of cleft palate in Northern Finland. Oral Surg Oral Med Oral Path Oral Radiol 2014; 117: 430-434. https://doi.org/10.1016/j.oooo.2013.12.409
de Blacam C, Smith S, Orr D. Surgery for velopharyngeal dysfunction: A systematic review of interventions and outcomes. Cleft Palate Craniofac J 2018; 55: 405-422. https://doi.org/10.1177/1055665617735102
Chen G, Zhong L. A bilateral musculomucosal buccal flap method for cleft palate surgery. J Oral Macillofac Surg 2003; 61: 1399-1404. https://doi.org/10.1016/j.joms.2003.06.001
Jackson IT, Moreira-Gonzalez AA, Rogers A, Beal BJ. The buccal flap-A useful technique in cleft palate repair? Cleft Palate Craniofac J 2004; 41: 144-151. https://doi.org/10.1597/02-124
Robertson AGN, McKeown DJ, Bello-Rojas G, et al. Use of buccal myomucosal flap in secondary cleft palate repair. PlastReconstr Surg 2008; 122: 910-917. https://doi.org/10.1097/PRS.0b013e318182368e
Ahl R, Ahmad, T, Harding-Bell A, Wharton L, Jordan A, Hall P. The buccinator mucomuscular flap: An in-depth analysis and evaluation of its role in the management of velopharyngeal dysfunction. Cleft Palate Craniofac J 2016; 53: e177-e184. https://doi.org/10.1597/14-283
Dias DK, Fernando PDC, Dissanayake RDA. Improvement of quality of speech in patients with velo-pharyngeal insufficiency corrected using a buccinator myomucosal flap. Ceyon Medical J 2016; 61: 130-134. https://doi.org/10.4038/cmj.v61i3.8349
Hill C, Hayden C, Riaz M, Leonard AG. Buccinator sandwich pushback: A new technique for treatment of secondary velopharyngeal incompetence. Cleft Palate Craniofac J 2004; 41: 230-237. https://doi.org/10.1597/02-146.1
Hens G, Sell D, Pinkstone M, et al. Palate lengthening by buccinator myomucosal flaps for velopharyngeal insufficiency. Cleft Palate Craniofac J 2013; 50: e84-e91. https://doi.org/10.1597/11-211
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6: e1000097. https://doi.org/10.1371/journal.pmed.1000097
Veau V. Division palatine, Paris: Masson 1931.
Mann RJ, Neaman KC, Armstrong SD, Ebner B, Bajnrauh R, Naum S. The double-opposing buccal flap procedure for palatal lengthening. PlastReconstr Surg 2011; 127: 2413- 2418. https://doi.org/10.1097/PRS.0b013e3182131d3e
Logjes RJH, van den Aardweg MTA, Blezer MMJ, van der Heul AMB, Breugem CC. Velopharyngeal insufficiency treated with levator muscle repositioning and unilateral myomucosal buccinator flap. J CranioMaxill Surg 2017; 54: 1-7. https://doi.org/10.1016/j.jcms.2016.10.012
Bzoch K. Communicative disorders related to cleft palate. Boston: Little Brown 1977.
Sell D, Harding A, Grunwell P. GOS.SP.ASS.’98: An assessment for speech disorders associated with cleft palate and/or velopharyngeal dysfunction (revised). Int J Lang CommunDisord 1999; 34: 17-33. https://doi.org/10.1080/136828299247595
Denadai R, Sabbag A, Amaral CE, et al. Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip. Braz J Otorhinolaryngol 2018; 84: 697-707. https://doi.org/10.1016/j.bjorl.2017.08.006
Agrawal K. Cleft palate repair and variations. Indian J Plast Surg 2009; 42: S102-S109. https://doi.org/10.1055/s-0039-1699382
Timbang MR, Gharb BB, Rampazzo A, Papay F, Zins J, Doumit G. A systematic review comparing Furlow double opposing Z-plasty and straight-line intravelarveloplasty methods of cleft palate repair. PlastReconstr Surg 2014; 134: 1014-1022. https://doi.org/10.1097/PRS.0000000000000637
American Speech and Hearing Association. 2019 Evidence Based Practice (EBP). https://www.asha.org/Research/EBP/
Henningsson G, Kuehn DP, Sell D, Sweeney T, Trost Cardamone JE, Whitehill TL. Universal parameters for reporting speech outcomes in individuals with cleft palate. Cleft Palate Craniofac J 2008; 45: 1-17. https://doi.org/10.1597/06-086.1
Allori AC, Kelley T, Meara JG, et al. A standard set of outcome measures for the comprehensive appraisal of cleft care. Cleft Palate Craniofac J 2017; 54: 540-554. https://doi.org/10.1597/15-292
Napoli JA, Vallino LC. Treating velopharyngeal inadequacy using bilateral buccal flap revision palatoplasty. Perspectives of the ASHA Special Interest Groups 2019; 4: 878-892. https://doi.org/10.1044/2019_PERS-SIG5-2019-0005
