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

posted on 23.10.2019 by Joseph A. Napoli, Linda D. Vallino
Purpose: The 2 most commonly used operations to treat
velopharyngeal inadequacy (VPI) are superiorly based
pharyngeal flap and sphincter pharyngoplasty, both of
which may result in hyponasal speech and airway
obstruction. The purpose of this article is to (a) describe
the bilateral buccal flap revision palatoplasty (BBFRP) as
an alternative technique to manage VPI while minimizing
these risks and (b) conduct a systematic review of the
evidence of BBFRP on speech and other clinical
outcomes. A report comparing the speech of a child with
hypernasality before and after BBFRP is presented.
Method: A review of databases was conducted for
studies of buccal flaps to treat VPI. Using the principles of
a systematic review, the articles were read, and data were
abstracted for study characteristics that were developed
a priori. With respect to the case report, speech and
instrumental data from a child with repaired cleft lip and
palate and hypernasal speech were collected and analyzed
before and after surgery.
Results: Eight articles were included in the analysis. The
results were positive, and the evidence is in favor of BBFRP
in improving velopharyngeal function, while minimizing the
risk of hyponasal speech and obstructive sleep apnea.
Before surgery, the child’s speech was characterized by
moderate hypernasality, and after surgery, it was judged to
be within normal limits.
Conclusion: Based on clinical experience and results
from the systematic review, there is sufficient evidence
that the buccal flap is effective in improving resonance
and minimizing obstructive sleep apnea. We recommend
it as a first-line approach in selected patients to manage

Supplemental Material S1.

Supplemental Material S2.

Napoli, J. A., & Vallino, L. D. (2019). Treating velopharyngeal inadequacy using bilateral buccal flap
revision palatoplasty. Perspectives of the ASHA Special Interest Groups. Advance online publication. https://doi.org/10.1044/2019_PERS-SIG5-2019-0005