An MRI Case Study: The Anatomic Cleft Restoration Concept Utilizing Buccal Flaps in a Primary Palatoplasty

Purpose: Primary palatoplasties using the Anatomic Cleft Restoration Philosophy uses the buccinator myomucosal flap (buccal flap) as the major tissue replacement flap to correct the tissue deficiency within the cleft palate malformation. The surgical approach aims to close the palate without tension, lengthen the palate, reconstruct the levator muscular sling, not inhibit craniofacial growth and achieve proper resonance for speech. The purpose of this study is to present preliminary data on velopharyngeal variables to demonstrate the muscle and tissue morphology in adults with cleft palate who have not received a secondary surgery for speech or orthognathic surgery. Methods: Magnetic resonance imaging was used to analyze velopharyngeal variables for 2 individuals with the buccal flap approach and 2 individuals who received a traditional cleft palate repair. Linear measurements were obtained and 2 velopharyngeal ratios were calculated. Results: All variables were compared to previously published normative data of velopharyngeal variables for individuals with non-cleft anatomy who are of the same race, sex, and of similar age. The individuals with the buccal flap approach presented with a similar velar length and levator length in comparison to individuals with non-cleft anatomy. The individuals with the buccal flap approach presented with a longer effective velar length and velar length in comparison to individuals with a traditional cleft palate repair. Visually, the individual with the buccal flap presents with a thicker tissue mass between the hard and soft palate junction. Conclusions: In this case study, individuals who received a primary palatoplasty with the buccal flap approach presented with a longer velum and effective velar length in comparison to individuals with a traditional cleft palate repair and those with non-cleft anatomy. This study highlights the utility of using magnetic resonance imaging to quantify the changes that occur to the velopharyngeal anatomy following the buccal flap surgical approach.