Does Buccal Flap Palatoplasty Improve Speech Outcomes?

Document Type

Article

Publication Date

9-2026

Publication Title

Plastic and Reconstructive Surgery. Global Open

Abstract

Objective: Primary palatoplasty technique selection is typically guided by surgeon preference and patient anatomy. Techniques, such as the Furlow double-opposing Z-plasty or Bardach two-flap, differ in the extent of mucoperiosteal dissection and muscular repositioning. The implications of palatoplasty technique for velopharyngeal function and related speech outcomes are incompletely defined, especially for the buccal flap palatoplasty. Existing studies are frequently limited by small sample sizes and data restricted to one or two techniques. We aimed to evaluate the relationship between palatoplasty technique, particularly the buccal flap technique, and speech outcomes.

Methods: A retrospective cohort study was conducted on all pediatric patients undergoing primary palatoplasty at our institution between January 2009-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. Associations between palatoplasty technique and speech outcomes were assessed using chi-square tests, logistic regression, and Tukey-adjusted pairwise comparisons. Operative times were compared using one-way ANOVA and Tukey-adjusted pairwise comparisons. Multivariable models were adjusted for age at repair. Continuous variables are non-normal and presented as median [IQR].

Results: There were 412 patients fitting the inclusion criteria. Patients were 62.4% White, 57.0% male, and 15.5% syndromic. The median cohort age at palatoplasty was 11.9 [9.4-14.3] months. Technique breakdown was 35.4% Furlow, 26.2% buccal flap, 17.2% Bardach, 11.4% unknown, 8.3% Von Langenbeck, 1.2% hybrid, and 0.2% Veau-Wardill-Kilner. Speech outcomes were assessed over a median follow-up time of 5.9 [2.1-9.4] years. Speech therapy was recommended in 63.6% of cases. VPI was diagnosed in 22.1%, a median of 3.8 [2.9-5.5] years after surgery. Speech surgery was required in 15.3%. There was a significant overall difference in speech therapy utilization across palatoplasty techniques (p< 0.001), and multiple pairwise comparisons adjusted for palatoplasty age demonstrated over two times the speech therapy requirements in patients who underwent buccal palatoplasty compared to Furlow (OR 2.28, 95% CI 1.04-5.01; p=0.035) and over four times compared to Von Langenbeck (OR 4.66, 95% CI 1.50-14.53; p=0.003). VPI diagnosis and speech surgery showed no differences across all techniques or within pairwise comparisons (all p≥0.085). Buccal flap palatoplasties demonstrated significantly longer operative time over all other techniques (all p< 0.001) and Bardach palatoplasties were significantly longer than Furlow (p=0.04).

Conclusion: The palatoplasty techniques evaluated in this study are equivalent with respect to post-operative VPI incidence rates and speech surgery requirements but not speech therapy utilization. Buccal flap palatoplasty demonstrated an increased likelihood of speech therapy recommendation/usage and longer operative time without a reduction in VPI. These findings highlight potential disadvantages for selection of this palatoplasty technique which should be taken into consideration in preoperative planning. Investigation into the physiological cause of increased speech therapy needs is warranted.

Volume

14

Issue

Suppl 4

First Page

4

Last Page

5

Comments

Michigan Academy of Plastic Surgeons 34th Biennial Scientific Meeting, July 12-15, 2026, Mackinac Island, MI

Helen DeVos Children’s Hospital

DOI

10.1097/01.GOX.0001276676.06047.dc

ISSN

2169-7574

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