The Double-Opposing Buccal Flap Procedure for Palatal Lengthening

Abstract

The double-opposing buccal flap is an effective technique for lengthening the palate, improving speech, and decreasing the risks of postoperative sleep apnea. All patients experienced a dramatic improvement in their resonance and intelligibility. This technique appears most effective in patients with intact velar movement who demonstrate a small to moderate posterior velar gap. The double-opposing buccal flap is a useful means of treating velopharyngeal dysfunction, thus serving as an adjunct when improving pharyngeal closure.

Cleft Palate Repair and Velopharyngeal Dysfunction

“…21,22 Some have advocated buccal mucosa flaps based anteriorly or posteriorly to patch small defects of oral or nasal mucosa. 23,24 Acellular dermal matrix has also been used to patch defects. 25 Although its effectiveness has been reported and it imparts no donor-site morbidity, it is avascular and can potentially act as a foreign body if it is not quickly revascularized.…”

The Buccinator Mucomuscular Flap: An In-Depth Analysis and Evaluation of Its Role in the Management of Velopharyngeal Dysfunction

“…The buccinator flap is a flexible procedure and may be used as a bilateral technique where the two mucomuscular flaps oppose each other to add extra tissue to both surfaces of the short palate. The use of double-opposing buccinator flaps in patients with persistent VPD has demonstrated promising postoperative results in improving abnormal resonance (Hill et al, 2004; Mann et al, 2011). The versatility of the buccinator flap is demonstrated not only in its use in repairing velopharyngeal closure defects but also in repairing large palatal fistulae contributing to postoperative VPD.…”

Morphology of the Musculus Uvulae In Vivo Using MRI and 3D Modeling Among Adults With Normal Anatomy and Preliminary Comparisons to Cleft Palate Anatomy

“…They also suggest that in participants with an absent or hypoplastic musculus uvulae, surgical augmentation of the velum in the position of the musculus uvulae might create a more favorable convexity to the nasal velar surface and aid velopharyngeal closure. Future research should examine the effect of varied surgical techniques that involve using fat and/or muscle to increase the velar midline, such as overlapping levator muscle fibers (Woo et al, 2014; Nguyen et al, 2015), buccal fat pad graft (Kim, 2001; Pinto et al, 2007; Pappachan and Vasant, 2008; Levi et al, 2009; Yamaguchi et al, 2016), and bilateral buccal flap (Mann and Fisher, 1997; Mann et al, 2011). Although it is possible these techniques contribute to the role of the musculus uvulae as a space-occupying muscle (particularly in a state when the muscle is hypoplastic), muscle imaging has yet to confirm these speculations.…”