BBFRP as a Technique to Manage VPI (Napoli & Vallino, 2019)

Purpose: The 2 most commonly used operations to treatvelopharyngeal inadequacy (VPI) are superiorly basedpharyngeal flap and sphincter pharyngoplasty, both ofwhich may result in hyponasal speech and airwayobstruction. The purpose of this article is to (a) describethe bilateral buccal flap revision palatoplasty (BBFRP) asan alternative technique to manage VPI while minimizingthese risks and (b) conduct a systematic review of theevidence of BBFRP on speech and other clinicaloutcomes. A report comparing the speech of a child withhypernasality before and after BBFRP is presented.Method: A review of databases was conducted forstudies of buccal flaps to treat VPI. Using the principles ofa systematic review, the articles were read, and data wereabstracted for study characteristics that were developeda priori. With respect to the case report, speech andinstrumental data from a child with repaired cleft lip andpalate and hypernasal speech were collected and analyzedbefore and after surgery.Results: Eight articles were included in the analysis. Theresults were positive, and the evidence is in favor of BBFRPin improving velopharyngeal function, while minimizing therisk of hyponasal speech and obstructive sleep apnea.Before surgery, the child’s speech was characterized bymoderate hypernasality, and after surgery, it was judged tobe within normal limits.Conclusion: Based on clinical experience and resultsfrom the systematic review, there is sufficient evidencethat the buccal flap is effective in improving resonanceand minimizing obstructive sleep apnea. We recommendit as a first-line approach in selected patients to manageVPI.Supplemental Material S1. Supplemental Material S2.Napoli, J. A., & Vallino, L. D. (2019). Treating velopharyngeal inadequacy using bilateral buccal flaprevision palatoplasty. Perspectives of the ASHA Special Interest Groups. Advance online publication. https://doi.org/10.1044/2019_PERS-SIG5-2019-0005