LAUSR

BACKGROUND Velopharyngeal insufficiency (VPI) is a complication following primary palatoplasty that can lead to hypernasality of the voice and other speech problems. The conversion Furlow palatoplasty for VPI can be done with the addition of buccal flaps to provide additional tissue for palatal repair. In this study we aimed to determine the effectiveness of buccal flaps with conversion Furlow in secondary management of VPI. METHODS A retrospective review of patients undergoing surgical repair of VPI between 2016 and 2020 was performed. Patients underwent either conversion Furlow palatoplasty alone (FA) or conversion Furlow with buccal flaps (FB) for VPI after primary straight-line repair of the palate. We reviewed medical records to collect demographics, operative information, and preoperative and postoperative speech scores. RESULTS Of the 77 patients in the study, 16 (21%) had a revision that incorporated buccal flaps. The median age at cleft palate revision surgery was 8.97 years in the FA group and 7.96 years in the FB group (p = 0.337). In the FA group, 4 patients (7%) developed a postoperative fistula, compared to 0 patients in the FB group. The average time to follow-up after revision surgery was 3.4 years (7 months - 5.9 years). Both cohorts demonstrated a decrease in hypernasality and total parameter scores postoperatively. CONCLUSIONS The use of buccal flaps in revision Furlow palatoplasty could decrease risk for postoperative complications. The use of data from a larger patient population from multiple institutions is warranted to determine true significance.