Buccal Flap Use in Primary Palatoplasty Does Not Decrease Velopharyngeal Insufficiency

Authors

• Caroline E. Baker, Pediatric Research Operations - Corewell Health West
• Abigail Teitelbaum, General Surgery Resident - Corewell Health East
• Michael Acheampong, Michigan State University College of Human Medicine Medical Student
• Antonio Ysunza, Physical Medicine & Rehabilitation- Corewell Health East
• Kongrit Chaiyasate, Plastic Surgery - Corewell Health East
• Anna R. Carlson, Pediatrics - Craniofacial Surgery - Corewell Health West
• John A. Girotto, Plastic Surgery - Corewell Health West

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Cleft palate repair techniques differ in the extent of mucoperiosteal dissection and muscular transposition. The implications of palatoplasty technique for velopharyngeal function are incompletely understood. The primary objective of this study is to evaluate the relationship between palatoplasty technique and speech outcomes, specifically whether the use of a buccal flap at the time of primary palatoplasty affects the rate of velopharyngeal insufficiency (VPI).

A retrospective cohort study was conducted on patients who underwent palatoplasty between January 2015-January 2025. Patients with submucous clefts and those not seen in the clinic following surgery were excluded. Demographics, intraoperative variables, and speech outcomes were collected. Chi-square and Kruskal-Wallis tests were conducted in R to assess associations between palatoplasty technique and outcomes and differences in operative time. Continuous variables are non-normal and presented as median [IQR].

There were 240 patients fitting the inclusion criteria. Patients were 60% male and 11.3 [9.3-12.9] months old at palatoplasty. Technique breakdown was 43.8% Furlow double-opposing Z-plasty, 26.3% Bardach two-flap, 12.1% Von Langenbeck, and 14.2% buccal flap, 2.1% hybrid, and 1.7% unknown. Speech outcomes were assessed over 3.5 [1.3-6.2] years. Speech therapy was recommended in 61.7% of cases. VPI was diagnosed in 10.4% of cases a median of 38.9 [31.0-45.3] months after surgery. Speech surgery was required in 8.8%. Palatoplasty technique was not associated with VPI or speech therapy or surgery requirements (all p>0.05). Operative times for the buccal flap palatoplasty were significantly longer than other techniques (4.1 [3.8-4.3] hours compared to a maximum of 2.2 [1.7-2.5] for other techniques; p< 0.001).

The palatoplasty techniques evaluated in this study are equivalent with respect to speech-related outcomes. The buccal flap primary palatoplasty technique required increased operative time without a measurable advantage for speech outcomes. A future direction of study is to increase the population examined to increase statistical power.

Recommended Citation

Baker CE, Teitelbaum A, Acheampong M, Ysunza A, Chaiyasate K, Carlson AR, Girotto JA. Buccal flap use in primary palatoplasty does not decrease velopharyngeal insufficiency. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2113