Double-opposing Z-Plasty Extended with a Pedicled Buccal Fat Pad Flap for Correcting Velopharyngeal Insufficiency after Primary Palatoplasty

2021 ◽  
pp. 105566562110471
Author(s):  
Hojin Park ◽  
Jin Mi Choi ◽  
Tae Suk Oh
Keyword(s):  
Soft Palate ◽  
Surgical Outcomes ◽  
Velopharyngeal Insufficiency ◽  
Moderate Degree ◽  
Fat Pad ◽  
Buccal Fat Pad ◽  
Pharyngeal Wall ◽  
Mucosal Flap ◽  
Velopharyngeal Closure ◽  
Submucous Cleft Palate

Introduction Furlow double-opposing Z-plasty (DOZ) lengthens the soft palate; however, this lengthening is achieved at the expense of increased mucosal flap tension. Thus, its use is limited in patients with severe tension applied on mucosal flap after DOZ. In this study, DOZ was combined with a buccal fat pad (BFP) flap to maximize palatal lengthening and muscle repositioning. Methods This study included patients who underwent surgical correction for velopharyngeal insufficiency between December 2016 and February 2019. Patients with more than moderate degree hypernasality following primary palatoplasty were included in the study. Patients younger than 4 years of age, those with a submucous cleft palate, or syndromic patients were excluded. Speech outcomes were investigated for those who underwent DOZ only (DOZ group, n = 17) and those in whom a BFP was used (BFP group, n = 15) pre- and postoperatively. The velopharyngeal gaps between the uvula and pharyngeal wall were measured before and immediately after surgery to estimate the palatal length. Results Most patients who received a BFP showed improvement in hypernasality. However, the hypernasality of the DOZ group was more severe than that of the BFP group (p = 0.023). The extent of palatal lengthening was 4.4 ± 1.7 mm and 7.5 ± 2.1 mm in the DOZ and BFP groups, respectively (p = 0.001). Conclusions BFPs reduced the tension of the DOZ mucosal flap and maximized palatal lengthening and muscle repositioning. They promoted velopharyngeal closure in patients with moderate and moderate-to-severe velopharyngeal insufficiency. Hence, our method improves the surgical outcomes of patients with velopharyngeal insufficiency after primary palatoplasty.

scholarly journals Use of a buccinator myomucosal flap and bilateral pedicled buccal fat pad transfer in wide palatal fistula repair: a case report

2021 ◽  
Vol 22 (4) ◽  
pp. 209-213
Author(s):  
Jin Mi Choi ◽  
Hojin Park ◽  
Tae Suk Oh
Keyword(s):  
Young Patients ◽  
Velopharyngeal Insufficiency ◽  
Fat Pad ◽  
Buccal Fat Pad ◽  
Palatal Fistula ◽  
Sphincter Pharyngoplasty ◽  
Free Closure ◽  
Buccinator Myomucosal Flap ◽  
Myomucosal Flap

Primary palatoplasty for cleft palate places patients at high risk for scarring, altered vascularity, and persistent tension. Palatal fistulas are a challenging complication of primary palatoplasty that typically form around the hard palate–soft palate junction. Repairing palatal fistulas, particularly wide fistulas, is extremely difficult because there are not many choices for closure. However, a few techniques are commonly used to close the remaining fistula after primary palatoplasty. Herein, we report the revision of a palatal fistula using a pedicled buccal fat pad and palatal lengthening with a buccinator myomucosal flap and sphincter pharyngoplasty to treat a patient with a wide palatal fistula. Tension-free closure of the palatal fistula was achieved, as well as velopharyngeal insufficiency (VPI) correction. This surgical method enhanced healing, minimized palatal contracture and shortening, and reduced the risk of infection. The palate healed with mucosalization at 2 weeks, and no complications were noted after 4 years of follow-up. Therefore, these flaps should be considered as an option for closure of large oronasal fistulas and VPI correction in young patients with wide palatal defects and VPI.

scholarly journals Prosthetic Rehabilitation of Velopharyngeal Insufficiency: Pharyngeal Obturator Prostheses with Different Retention Mechanisms

2010 ◽  
Vol 04 (01) ◽  
pp. 081-087 ◽  
Author(s):  
Suleyman Hakan Tuna ◽  
Gurel Pekkan ◽  
Hasan Onder Gumus ◽  
Alper Aktas
Keyword(s):  
Soft Palate ◽  
Velopharyngeal Insufficiency ◽  
Prosthetic Rehabilitation ◽  
Retention Mechanisms ◽  
Velopharyngeal Closure ◽  
Intelligible Speech

ABSTRACTPharyngeal obturator prostheses restore the congenital or acquired defects of the soft palate and allow adequate closure of palatopharyngeal sphincter. Two patients with soft palate defect and subsequent velopharyngeal insufficiency were rehabilitated using pharyngeal obturator prostheses which had different retention mechanisms. Since it is necessary for swallowing and intelligible speech, the patients were examined in terms of adequate velopharyngeal closure after prosthetic treatment. The results were satisfying for both the patients and physicians. (Eur J Dent 2010;4:81-87)

Morphologic Significance of Bifid Uvula

PEDIATRICS ◽  
1985 ◽  
Vol 75 (3) ◽  
pp. 553-561
Author(s):  
Robert J. Shprintzen ◽  
Richard H. Schwartz ◽  
Avron Daniller ◽  
Lynn Hoch
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Velopharyngeal Insufficiency ◽  
Pediatric Practice ◽  
Submucous Cleft Palate ◽  
Hypernasal Speech ◽  
Definition Of

Bifid uvula is often regarded as a marker for submucous cleft palate although this relationship has not been fully confirmed. The reason for the tacitly assumed connection between these two anomalies has, in part, been perpetuated by the generally accepted definition of submucous cleft palate as the triad of bifid uvula, notching of the hard palate, and muscular diastasis of the soft palate. Recently, investigations have provided evidence of more subtle manifestations of submucous cleft palate by the use of nasopharyngoscopic examination of the palate and pharynx. It has been determined that submucous cleft palate can occur even when a peroral examination shows an intact uvula. This finding places the "marker" relationship in question. In order to determine the frequency of association between bifid uvula and submucous clefting, a total ascertainment of children with bifid uvula from a suburban pediatric practice was examined nasopharyngoscopically. It was determined that in all but two cases, children with bifid uvula had some or all of the landmarks of submucous cleft palate. Several of the children were found to have velopharyngeal insufficiency and mildly hypernasal speech. This finding prompts caution in the recommendation of adenoidectomy in the presence of bifid uvula.

Closure of Palatal Defects Following Excision of Palatal Pleomorphic Adenomas

2008 ◽  
Vol 9 (6) ◽  
pp. 99-107 ◽  
Author(s):  
Samet Inal ◽  
Alper Alkan
Keyword(s):  
Postoperative Bleeding ◽  
Surgical Excision ◽  
Fat Pad ◽  
Buccal Fat Pad ◽  
Mucosal Flap ◽  
Partial Necrosis ◽  
Secondary Bleeding ◽  
Pleomorphic Adenomas ◽  
Secondary Healing ◽  
Palatal Defect

Aim The purpose of this study is to compare different palatal defect closure techniques following excision of palatal pleomorphic adenomas (PPA) in four cases and to review the associated dental literature. Methods and Materials Excision of all four PPA's was performed under local anesthesia. Three different closure techniques used among the cases included an intact mucosal flap, a pedicled buccal fat pad, or secondary healing. Results On average the defects healed completely at two months following surgery. While final healing was ideal, partial necrosis of the mucosal flap and minimal postoperative bleeding were seen as complications in two cases. Conclusion Regardless of the size of the palatal defect created by the surgical excision of a PPA it heals ideally by secondary healing. However, the possibility of secondary bleeding and infection during the healing period should be kept in mind. Citation Alkan A, Inal S. Closure of Palatal Defects Following Excision of Palatal Pleomorphic Adenomas. J Contemp Dent Pract 2008 September; (9)6:099-107.

Functional anatomy of the soft palate applied to wind playing

2010 ◽  
Vol 25 (4) ◽  
pp. 183-189 ◽  
Author(s):  
Alison Evans ◽  
Bronwen Ackermann ◽  
Tim Driscoll
Keyword(s):  
Soft Palate ◽  
High Pressures ◽  
Prolonged Exposure ◽  
Functional Anatomy ◽  
Velopharyngeal Insufficiency ◽  
Related Disorder ◽  
Velopharyngeal Closure ◽  
Teachers And Students ◽  
Wind Players ◽  
Air Passage

Wind players must be able to sustain high intraoral pressures in order to play their instruments. Prolonged exposure to these high pressures may lead to the performance-related disorder velopharyngeal insufficiency (VPI). This disorder occurs when the soft palate fails to completely close the air passage between the oral and nasal cavities in the upper respiratory cavity during blowing tasks, this closure being necessary for optimum performance on a wind instrument. VPI is potentially career threatening. Improving music teachers' and students' knowledge of the mechanism of velopharyngeal closure may assist in avoiding potentially catastrophic performance-related disorders arising from dysfunction of the soft palate. In the functional anatomy of the soft palate as applied to wind playing, seven muscles of the soft palate involved in the velopharyngeal closure mechanism are reviewed. These are the tensor veli palatini, levator veli palatini, palatopharyngeus, palatoglossus, musculus uvulae, superior pharyngeal constrictor, and salpingopharyngeus. These muscles contribute to either a palatal or a pharyngeal component of velopharyngeal closure. This information should guide further research into targeted methods of assessment, management, and treatment of VPI in wind musicians.

Sphincter Pharyngoplasty for Velopharyngeal Dysfunction

2019 ◽  
pp. 535-540
Author(s):  
Donald S. Mowlds ◽  
Raj M. Vyas
Keyword(s):  
Sleep Apnea ◽  
Upper Airway ◽  
Posterior Pharyngeal Wall ◽  
Upper Airway Obstruction ◽  
Velopharyngeal Insufficiency ◽  
Airway Compromise ◽  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Velopharyngeal Closure ◽  
Sphincter Pharyngoplasty

The surgical correction of velopharyngeal insufficiency (VPI) seeks to augment the deficient aspect of the velopharyngeal apparatus. The objective of the sphincter pharyngoplasty is to narrow the velopharyngeal gap transversely by addressing lateral pharyngeal wall motion. Superiorly based lateral palatopharyngeus myomucosal flaps are transposed 90 degrees and inset into the posterior pharyngeal wall mucosa. Following sphincter pharyngoplasty, the patient is monitored overnight for impending airway compromise. If symptomatic VPI persists, repeat diagnostic evaluation is performed. Success is determined by acceptable perceptual oral resonance, adequate velopharyngeal closure on endoscopy, and the absence of upper airway obstruction or sleep apnea.

Nasendoscopic Evaluation of Stress Velopharyngeal Insufficiency in Wind Musicians: A Pilot Study

2015 ◽  
Vol 30 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Alison Evans ◽  
Tim Driscoll ◽  
Jonathan Livesey ◽  
David Fitzsimons ◽  
Bronwen Ackermann
Keyword(s):  
Soft Palate ◽  
Objective Assessment ◽  
Velopharyngeal Insufficiency ◽  
Air Leak ◽  
Speech Language Pathologist ◽  
Wind Instrument ◽  
Velopharyngeal Closure ◽  
Before And After ◽  
And Function

OBJECTIVE: To investigate the anatomy and function of the velopharyngeal mechanism in musicians who experience symptoms of stress velopharyngeal insufficiency (VPI) compared to musicians who do not. METHODS: The velopharyngeal mechanism of 13 musicians, 8 with reported symptoms of stress VPI and 5 without, were evaluated using video nasendoscopy before and after 30 minutes of playing. All nasendoscopic recordings were rated by an external speech-language pathologist and ear, nose and throat surgeon for maintenance of velopharyngeal closure, type of velopharyngeal closure pattern, and velopharyngeal gap. RESULTS: Six out of 8 cases with stress VPI had nasal air leak during the assessment, 2 of whom had fatigue-related increased symptoms. Three controls had mild nasal air leak without affecting the consistency of soft palate seal nor quality of playing, suggesting that evidence of nasal air leak is not always symptomatic of stress VPI. All cases had unusual anatomical characteristics, such as the soft palate closing against an irregular surface on the posterior nasopharyngeal wall, which may cause insufficient velopharyngeal closure. Typically the soft palate contacted the nasopharyngeal wall higher when playing a wind instrument compared to during speech. CONCLUSION: Specific anatomical features and factors such as fatigue and stress may affect maintenance of velopharyngeal closure in persons with stress VPI. It is important that musicians with stress VPI are evaluated while playing their instrument. Future studies into stress VPI would benefit by including objective assessment components and some degree of quantifiable measurements.

Endoscopically Harvested Buccal Fat Pad Flap: A Review of Seven Cases

2019 ◽  
Author(s):  
Somasundaram Subramaniam ◽  
Ricardo Carrau
Keyword(s):  
Fat Pad ◽  
Buccal Fat Pad

scholarly journals Versatility of the pedicled buccal fat pad flap for the management of oroantral fistula: a retrospective study of 25 cases

2019 ◽  
Vol 41 (1) ◽  
Author(s):  
Jinyoung Park ◽  
Byung-do Chun ◽  
Uk-Kyu Kim ◽  
Na-Rae Choi ◽  
Hong-Seok Choi ◽  
...  
Keyword(s):  
Bone Graft ◽  
Graft Failure ◽  
Fistula Closure ◽  
Fat Pad ◽  
Buccal Fat Pad ◽  
Dental Surgery ◽  
Female Ratio ◽  
Maxillary Bone ◽  
Oroantral Fistula

Abstract Purpose Maxillary bone grafts and implantations have increased over recent years despite a lack of maxillary bone quality and quantity. The number of patients referred for oroantral fistula (OAF) due to implant or bone graft failure has increased, and in patients with an oroantral fistula, the pedicled buccal fat pad is viewed as a robust, reliable option. This study was conducted to document the usefulness of buccal fat pad grafts for oroantral fistula closure. Materials and methods We retrospectively studied 25 patients with OAF treated with a buccal fat pad graft from 2015 to 2018. Sex, age, OAF location, cause, duration, presence of systemic disease, smoking, previous dental surgery, and side effects were investigated. Results A total of 25 patients were studied. Mean patient age was 54.8 years, and the male to female ratio was 19:6. Causes of oroantral fistula were cyst enucleation, tumor resection, implant removal, bone graft failure, and extraction. Excellent results were obtained in 23 (92%) of the 25 patients. In the other two patients that both smoked, a small fistula was observed during follow-up. No recurrence of oroantral fistula was observed after 2 months to 1 year of follow-up. Conclusions The incidence of oroantral fistula is increasing due to implant and bone graft failures. Oroantral fistula closure using a pedicled buccal fat pad was found to have a high success rate.

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