Volume : IX, Issue : VIII, August - 2019

EVALUATION OF THE EFFICACY OF BUCCAL MYOMUCOSAL FLAP FOR THE CORRECTION OF VPI IN PRIMARY CLEFT PALATE.

Dr T. Mohana Rao, Dr P. Rajakullayappa, Dr D. Mukunda Reddy, Dr R. Srikanth, Dr N. Rambabu

Abstract :

Background: Normally the cleft palate patient is operated with intravelar veloplasty at the age of around 9 months to one year to attain optimal results. Following primary palatal surgery 5 to 39 % of patients have velopharyngeal incompetence causing them to have abnormal speech. There are many surgical procedures described in literature for primary correction of velopharyngeal incompetence in children. In Our pilot study of 10 cases to evaluate the efficacy of buccal myomucosal flap for VPI correction in primary cleft palate group was inspired by Ian T Jackson’s study, but was used for older age groups.VPI evaluation was done clinically by speech pathologists and assessed objectively by using videoflouroscopy in lateral view for velopharyngeal closure and nasal endoscopy for sphincteric action of velopharyngeal muscles. Aims and objectives To know normal palatal length in adults and normal velopharyngeal gap.To know whether soft palate length achieved following cleft palate repair with use of buccal myomucosal flap on nasal side was normal length or not . Observations were made immediately following surgery, after six months and after 2 years.To evaluate Velopharyngeal competence clinically, vedeoflouroscopy and with nasalendoscopy.To evaluate speech outcome based on the above parameters. Methods and materials : Study was prospective type.Measurement of Soft palate length in 10 normal adults under anesthesia.10 Primary cleft palate includes complete and incomplete that were attended during 2007 –2014. Age ranges between 8 – 25 years were included and Both sexes included.Soft palate length measured prior to surgery under anaesthesia Cleft palate repair done with intravelar veloplasty and nasal layer lengthening done with use of buccal myomucosal flap interposition at hard and soft palate junction, Oral layer closed in straight line were included.Immediate post operative soft palate length measures were included.Soft palate length and velopharyngeal gap measured at 6 months and at 2 years are included.Speech evaluation done clinically by speech pathologist at interval of 6 months and 2 years.Objective speech evaluation done by using videoflouroscopy and nasal endoscopy at 6 months and at 2 years Results Clinical evaluation of speech in study cases were done after 6 months showed ,in 40 % of cases normal speech observed, 20 % cases reasonable speech and remaining 40 % cases had bad speech with articulation problems and nasal emission. These patients are subjected for speech therapy. When velopharyngeal incompetence was objectively assessed with videoflouroscopy we found that in 6 out of 10 cases (60% ) velopharyngeal competence seen . Conclusion Though this study showed the usefulness of the buccal myomucosal flap in the improvement of speech significantly, especially in grown up children when compared to adults clefts, it improved the length of palate as well However this study being a small study ,though having good results when compared previous study groups. It needs further expansion with more data analysis to show more accurate results.

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Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

EVALUATION OF THE EFFICACY OF BUCCAL MYOMUCOSAL FLAP FOR THE CORRECTION OF VPI IN PRIMARY CLEFT PALATE., DR T.MOHANA RAO, DR P.RAJAKULLAYAPPA, 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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