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Use of buccal myomucosal flap for palatal lengthening in cleft palate patient: Experience of 20 cases.

Varghese D, Datta S, Varghese A - Contemp Clin Dent (2015)

Bottom Line: The buccal myomucosal flap was used in all 20 patients, and there was marked increase in the quality of speech as well as nasal regurgitation decreased.In patients with levator dysfunction due to poor primary surgery and glottal speech the results were inconclusive.Palate re-repair combined with a buccal myomucosal flap, occasionally in conjunction with other techniques, is an effective method for correcting failed cleft palate repairs.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Jodhpur Dental College, Jodhpur, Rajasthan, India.

ABSTRACT

Background: The purpose of this review was to assess the effectiveness of the buccal myomucosal flap in secondary repairs of cleft palate in 20 patients.

Patients and methods: Totally, 20 patients, who underwent secondary palatoplasty between 5 years and 8 years in which a buccal myomucosal flap was used, were reviewed retrospectively. All patients had undergone at least one previous attempted repair at other institutions. Indications for the secondary repair included velopharyngeal incompetence and/or oronasal fistula. Patients were evaluated preoperatively for oronasal fistula status, velopharyngeal competence, nasal resonance, speech quality, and nasal escape.

Results: The buccal myomucosal flap was used in all 20 patients, and there was marked increase in the quality of speech as well as nasal regurgitation decreased. In patients with levator dysfunction due to poor primary surgery and glottal speech the results were inconclusive.

Conclusion: Palate re-repair combined with a buccal myomucosal flap, occasionally in conjunction with other techniques, is an effective method for correcting failed cleft palate repairs. Minimum donor site morbidity and complication makes the buccal flap a useful armamentarium of a cleft surgeon.

No MeSH data available.


Related in: MedlinePlus

Healed flap for palatal fistula
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Figure 3: Healed flap for palatal fistula

Mentions: After infiltration with local anesthesia (lidocaine 0.05% plus 1:100.000 epinephrine), the Veau flaps are raised and extensively dissected from the nasal layer in the area of the soft palate. The levator musculature is then clearly exposed. The levator mechanism is then dissected completely from its anteromedial insertion onto the palate shelves. Division of the tendinous insertion of the palatopharyngeus and the fascia of von Troltz is carried out. This allows retropositioning of the soft palate without tension. The levator musculature is gently dissected off the nasal layer, which is then devoid of any other structure. The muscles come to lie at right angles to the long axis of the palate at the base of the uvula. The greater palatine neurovascular bundle to these muscles enters from a later position; it is clearly seen and carefully preserved during the dissection. The nasal layer is accurately reconstructed with 4–0 vicryl. The levator musculature is reconstructed by being sutured together and to the nasal layer with 4–0 vicryl sutures in the midline at the base of the uvula. After that, the nasal layer of the palate is divided transversely at approximately 0.5 cm behind the palatal shelves. The oral mucosa area over the cheek is then exposed and a buccal myomucosal flap measuring between 1.5 and 2 cm wide by 2.5 cm long is then raised. The flap is elevated together with a thin layer of the buccinator muscle, which improves its blood supply. The mucosal defect is closed with 4–0 chromic catgut. It is important to avoid opening the buccal fat fascia; this prevents the herniation of fat into the oral cavity. If this occurs, repositioning of the fat pad and suture of the flap donor site is enough to solve the problem. The parotid duct should be carefully preserved, but if injured, it is of no consequence; the parotid secretion always finds a way out. A generous tunnel is created posterior to greater palatine vessels, and the buccal flap is passed through it to fill the nasal layer defect. The buccal flap is sutured in place with 4.0 vicryl. The flap must be placed with the mucosal surface facing the nasal cavity, taking care not to twist the pedicle. This technique lengthens the nasal layer by 1.5–2 cm. Subperiosteal dissection is never performed on the posterior tuberosity on the left side even if closure is difficult. To prevent growth problems, submucosal dissection only should be performed. This, however, is a rare situation. Closure of the oral layer is achieved with interrupted 4–0 vicryl mattress sutures. This is a composite closure that includes the oral and nasal layers and posteriorly the reconstructed muscles [Figure 1]. The lateral raw areas on the hard palate can always be closed directly in all clefts and also with 4.0 vicryl sutures. The patients are discharged 1-day after the surgery with examination of the palate and are seen 1-month later at the clinic unless something unforeseen occurs. Postoperatively, there is slight edema on the side from which Buccal Myo Mucosal Flap (BMMF) is taken, which subsides eventually after proper administration of antiinflammatory drugs and positioning [Figure 3].


Use of buccal myomucosal flap for palatal lengthening in cleft palate patient: Experience of 20 cases.

Varghese D, Datta S, Varghese A - Contemp Clin Dent (2015)

Healed flap for palatal fistula
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374316&req=5

Figure 3: Healed flap for palatal fistula
Mentions: After infiltration with local anesthesia (lidocaine 0.05% plus 1:100.000 epinephrine), the Veau flaps are raised and extensively dissected from the nasal layer in the area of the soft palate. The levator musculature is then clearly exposed. The levator mechanism is then dissected completely from its anteromedial insertion onto the palate shelves. Division of the tendinous insertion of the palatopharyngeus and the fascia of von Troltz is carried out. This allows retropositioning of the soft palate without tension. The levator musculature is gently dissected off the nasal layer, which is then devoid of any other structure. The muscles come to lie at right angles to the long axis of the palate at the base of the uvula. The greater palatine neurovascular bundle to these muscles enters from a later position; it is clearly seen and carefully preserved during the dissection. The nasal layer is accurately reconstructed with 4–0 vicryl. The levator musculature is reconstructed by being sutured together and to the nasal layer with 4–0 vicryl sutures in the midline at the base of the uvula. After that, the nasal layer of the palate is divided transversely at approximately 0.5 cm behind the palatal shelves. The oral mucosa area over the cheek is then exposed and a buccal myomucosal flap measuring between 1.5 and 2 cm wide by 2.5 cm long is then raised. The flap is elevated together with a thin layer of the buccinator muscle, which improves its blood supply. The mucosal defect is closed with 4–0 chromic catgut. It is important to avoid opening the buccal fat fascia; this prevents the herniation of fat into the oral cavity. If this occurs, repositioning of the fat pad and suture of the flap donor site is enough to solve the problem. The parotid duct should be carefully preserved, but if injured, it is of no consequence; the parotid secretion always finds a way out. A generous tunnel is created posterior to greater palatine vessels, and the buccal flap is passed through it to fill the nasal layer defect. The buccal flap is sutured in place with 4.0 vicryl. The flap must be placed with the mucosal surface facing the nasal cavity, taking care not to twist the pedicle. This technique lengthens the nasal layer by 1.5–2 cm. Subperiosteal dissection is never performed on the posterior tuberosity on the left side even if closure is difficult. To prevent growth problems, submucosal dissection only should be performed. This, however, is a rare situation. Closure of the oral layer is achieved with interrupted 4–0 vicryl mattress sutures. This is a composite closure that includes the oral and nasal layers and posteriorly the reconstructed muscles [Figure 1]. The lateral raw areas on the hard palate can always be closed directly in all clefts and also with 4.0 vicryl sutures. The patients are discharged 1-day after the surgery with examination of the palate and are seen 1-month later at the clinic unless something unforeseen occurs. Postoperatively, there is slight edema on the side from which Buccal Myo Mucosal Flap (BMMF) is taken, which subsides eventually after proper administration of antiinflammatory drugs and positioning [Figure 3].

Bottom Line: The buccal myomucosal flap was used in all 20 patients, and there was marked increase in the quality of speech as well as nasal regurgitation decreased.In patients with levator dysfunction due to poor primary surgery and glottal speech the results were inconclusive.Palate re-repair combined with a buccal myomucosal flap, occasionally in conjunction with other techniques, is an effective method for correcting failed cleft palate repairs.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Jodhpur Dental College, Jodhpur, Rajasthan, India.

ABSTRACT

Background: The purpose of this review was to assess the effectiveness of the buccal myomucosal flap in secondary repairs of cleft palate in 20 patients.

Patients and methods: Totally, 20 patients, who underwent secondary palatoplasty between 5 years and 8 years in which a buccal myomucosal flap was used, were reviewed retrospectively. All patients had undergone at least one previous attempted repair at other institutions. Indications for the secondary repair included velopharyngeal incompetence and/or oronasal fistula. Patients were evaluated preoperatively for oronasal fistula status, velopharyngeal competence, nasal resonance, speech quality, and nasal escape.

Results: The buccal myomucosal flap was used in all 20 patients, and there was marked increase in the quality of speech as well as nasal regurgitation decreased. In patients with levator dysfunction due to poor primary surgery and glottal speech the results were inconclusive.

Conclusion: Palate re-repair combined with a buccal myomucosal flap, occasionally in conjunction with other techniques, is an effective method for correcting failed cleft palate repairs. Minimum donor site morbidity and complication makes the buccal flap a useful armamentarium of a cleft surgeon.

No MeSH data available.


Related in: MedlinePlus