Volume : IX, Issue : VIII, August - 2019

EFFICACY OF BILATERAL BUCCAL MUCOSAL FLAPS IN MODEARATE AND SEVERE VELOPHARYNGEAL INCOMPETENCE

Dr T. Mohana Rao, Dr A. Ravichander Rao, Dr D. Mukunda Reddy, Dr R. Srikanth, Dr N. Rambabu

Abstract :

Background: The goal of cleft surgery s to close the gap the palate with a technique and timing that produce optimal speech and minimize facial growth disturbances. Success is not the domain of any single method or protocol,but the results of the experienced surgeon working with a team of cleft specialists and following solid principle.But even in the best hands,5 to 38 % of the patients develp velopharyngeal incompetence following primary palatal surgery1. Velopharyngeal incompetence is a multifactorial problem caused by a deep nasopharynx,poor lateral wall mobility,and structural insuffiency of the soft palate or lateralposterior pharyngeal walls2,17. Restoration of normal anatomy is one of the fundamental aims of plastic surgery and the buccal myomucosal flap offers a more anatomical correction of short palates than traditional repairs.It is also technically easier,than a pharyngeal flap,tailoring the flap to the degree of preoperative velopharyngeal incompetence is often difficult.This study was contemplated to evaluate to efficacy of bilateral buccal mucosal flaps in the correction of moderate and severe VPI(>5 mm VP gap on phonation). AIMS AND OBJECTIVES: Efficacy of bilateral buccal myomucosal flaps in surgical correction of moderate and severe VPI(velopharyngeal gap >5 mm).Degree of palatal length achieved post operatively. MATERIALS AND METHODS: It is a prospective study comprising 12 Patients who underwent secondary palatolasty between 2006 to 2014 june in which bilateral buccal myomucosal flap was used were reviewed retrospectively.Inclusion criterion: All patients who underwent VPI correction by bilateralbuccal mucosal flap with a preoperative VPI gap More than 5 mm and cases operated by a single surgeon were included in the study. Methods: 1. All the data of patients who had undergone VPI correction by bilateral myomucosal flap were retieved. 2. Patients selected were those who had crossed a minimum of six months after the primary palatoplasty. 3. At follow up patients were subjected to speech evaluation, and video fluoroscopy(the palate length and velophharyngeal gap were measured). Results In our study, done in patients with moderate and severe VPI with VP gap (>5 mm) a significant improvement in the VPI in 92% (11/12) patients was observed.Compltete closure of VPI could be successfully achieved in 59% (7/12).In 33% (4/12) the persistent velopharyngeal gap was less than 5 mm. Conclusion: The buccal myomucosal flap is an effective technique that can used in secondary palatal repairs as a single procedure or in conjunction with other techniques.It is effective in treating short soft paltes,fistula in the palate,for poor speech. The buccal myomucosal flap allows both closure and lengthening of the soft palte without tension.Accurate reconstruction and repositioning of the muscle sling improves velopharyngeal incompetence and consequently speech and hyper resonance. The buccal mucosa should be harvested with the buccinators muscle for increased survival and the dissection should be meticulous at the pterygomandibular raphe,where the vessels enter the flap.

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Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

EFFICACY OF BILATERAL BUCCAL MUCOSAL FLAPS IN MODEARATE AND SEVERE VELOPHARYNGEAL INCOMPETENCE, DR T.MOHANA RAO, DR A. RAVICHANDER RAO, DR D.MUKUNDA REDDY, DR R.SRIKANTH, DR N.RAMBABU INDIAN JOURNAL OF APPLIED RESEARCH : Volume-9 | Issue-8 | August-2019

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