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Buccal Myomucosal Flap as a First-Line Treatment for Velopharyngeal Deficiency: A Single-Institution Retrospective Analysis of a 13-year Trend in Procedure Utilization
Nisha K. Vora
1, Leah Prishak
1, Golibe Okoli
1, Erona
1, David Low
1, Jesse Taylor
1, Jordan W. Swanson
1, Scott Bartlett
1, Oksana A. Jackson
1, Joseph A. Napoli
1
1Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
Background: Velopharyngeal dysfunction (VPD) after cleft palate repair remains a significant clinical challenge. Pharyngeal based procedures including the posterior pharyngeal flap (PPF) and sphincter pharyngoplasty (SPP) have historically been first-line treatments, whereas palatal lengthening with buccal myomucosal flaps (BMMF), has become increasingly more popular and has demonstrated safety and efficacy. Few studies have examined longitudinal institutional trends in VPD procedure selection. We aim to characterize temporal trends in VPD procedure utilization at a high-volume pediatric craniofacial center.
Methods: A retrospective cohort review of non-syndromic patients who underwent post-palatoplasty VPD treatment at a tertiary pediatric referral center (2013-2025). Procedures include BMMF, PPF, SPP, and Furlow Conversion. Recorded variables included age at surgery, indication, procedure type, surgeon, and postoperative course.
Results: A total of 178 patients were identified and included in the primary analysis. Of these, 82 (46.1%) underwent BMMF, 57 (32.0%) PPF, 22 (12.4%) SPP, and 17 (9.6%) Furlow revision. Over time, the proportional use of BMMF increased steadily, rising from 11.1% in 2013 to 45.5% in 2021 and exceeding PPF in 2022 (55.2% vs 41.4%) and 2023 (68.4% vs 15.8%). In multivariable logistic regression (N = 138 BMMF + PPF cases), each calendar year was independently associated with 35.4% higher odds of BMMF selection (OR 1.354, 95% CI 1.16–1.58, p < 0.0001), controlling for patient age and surgeon. New-onset OSA was notably higher in PPF (13.0%) compared to BMMF (1.7%) and SPP (4.5%).
Conclusion: These findings demonstrate a significant shift toward BMMF as the primary surgical intervention for VPD after cleft palate repair at a high-volume pediatric craniofacial center. This trend persisted after adjustment for age and surgeon, suggesting a true change in institutional practice. BMMF was associated with lower postoperative OSA rates than PPF, supporting its use as a safer first-line treatment. Speech outcome data remain under active investigation.
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