Addition of a Buccinator Musculomucosal Flap Improves Surgical Outcomes of Conventional two-Flap Palatoplasty: A Comparative Study.

OBJECTIVE: The surgical outcomes of novel two-flap palatoplasty adding a buccinator musculomucosal flap were compared with those of conventional two-flap palatoplasty to clarify the effects of lengthening the nasal mucosa of the soft palate using a BMMF in cleft lip and palate or cleft palate cases. DESIGN: Retrospective, comparative study. SETTING: Tertiary, cleft team. PATIENTS: Non-syndromic patients undergoing primary cleft palate repair using two-flap palatoplasty with BMMF (BMMF group) or conventional two-flap palatoplasty (non-BMMF group). INTERVENTIONS: Palatoplasty between January 2012 and March 2020. MAIN OUTCOME MEASURES: Perceptual Japanese speech evaluation, rate of an indication for additional speech surgery (AS), rate of incidence of oronasal fistula (IF) including spontaneously closing fistula, and rate of occurrence of oronasal fistula (OF) present for more than 3 months. RESULTS: Of 92 analyzed patients, 70 received two-flap palatoplasty with BMMF and 22 received two-flap palatoplasty. In the BMMF and non-BMMF groups, the respective percentage of hypernasality (no, mild) was 91.4% and 77.2%, no nasal emission was 71.4% and 63.6%, velopharyngeal function (competent, borderline competent) was 83.7% and 77.4%, intelligibility (very good, good) was 93.7% and 86.4%, AS was 1.4% and 13.6%, IF was 7.1% and 36.4%, and OF was 1.4% and 9.1%. Significant improvements were observed for AS (p = 0.0412) and IF (p = 0.00195) in the BMMF group, with no recorded major adverse effects. CONCLUSION: Adding a BMMF on the nasal side of the soft palate to conventional two-flap palatoplasty significantly improved postoperative outcomes. This approach may therefore be a good option for cleft palate treatment.

Autologous fat transplantation to the velopharynx for treating mild velopharyngeal insufficiency: A 10-year experience.

BACKGROUND: For the last two decades, autologous fat transplantation has been used to treat mild velopharyngeal insufficiency (VPI); however, there is still disagreement about its effectiveness. The aim of the study was to evaluate the procedure by using speech analysis and magnetic resonance imaging (MRI). PATIENTS AND METHODS: This is a prospective study of 47 non-syndromic patients with mild VPI who underwent autologous fat transplantation to the velopharynx between 2006 and 2015. Thirty-two patients had a cleft palate, all of which had been repaired before fat transplantation. Eight patients developed VPI after adenotonsillectomy, one after uvulo-palatoplasty and six had VPI of unknown etiology. Twelve patients underwent two procedures of fat transplantation. Preoperative and 1-year postoperative audio recordings were blinded for scoring independently by three senior speech therapists on a five-point scale. Preoperative and 1-year postoperative MRIs were obtained during phonation, measuring the velopharyngeal distance and the velopharyngeal gap area. Correlations between the speech outcomes and MRI were calculated. RESULTS: Audible nasal emission was the only speech parameter that improved significantly postoperatively (p = 0.005). A significant reduction in both velopharyngeal distance (p < 0.005) and the gap area (p < 0.005) was found after treatment. A significant improvement in the mobility of the velum was observed after treatment (p = 0.03). There was no significant correlation between speech outcomes and MRI. CONCLUSIONS: Autologous fat transplantation for the treatment of mild VPI, although significantly reducing audible nasal emission, made no significant improvement in hypernasality or nasal turbulence. No complications were observed.

Multiple phonetically trained-listener comparisons of speech before and after articulatory intervention in two children with repaired submucous cleft palate.

Cleft Palate (CP) assessments based on phonetic transcription are the "gold standard" therapy outcome measure, despite reliability difficulties. Here we propose a novel perceptual evaluation, applied to ultrasound-visual biofeedback (U-VBF) therapy and therapy using visual articulatory models (VAMs) for two children with repaired submucous CP. Three comparisons were made: post VAM, post U-VBF and overall pre- and post-therapy. Twenty-two phonetically-trained listeners were asked to determine whether pre- or post-therapy recordings sounded "closer to the English target", using their own implicit phonological knowledge (prompted via orthographic representation). Results are compared with segment-oriented percent target consonant correct (PTCC) derived from phonetic transcriptions. Listener judgements and PTCC suggest that both children made improvements using both VAM and U-VBF. Statistical analysis showed listener agreement in each comparison, though agreement was weak. However, perceptual evaluation offers a straightforward method of evaluating the effectiveness of interventions and can be used by phonetically trained or lay listeners.