Background: Tissue augmenting palatoplasty (TAP) is a novel technique to address velopharyngeal insufficiency (VPI) risk following pharyngoplasty. We discuss our center’s technique using various TAP modalities, including buccal myomucosal flaps (BMMF), buccal fat flaps (BFF), and others and the effect on sleep, speech, and surgical outcomes.
Methods: A retrospective cohort study comparing non-syndromic primary TAP patients, syndromic primary TAP patients, and non-TAP Furlow palatoplasty control patients who presented to a single tertiary care center between 2017 and 2021. Demographic, speech, sleep, and surgical outcomes were summarized and compared between groups.
Results: 157 records were analyzed, including 62 non-syndromic primary TAP, 51 syndromic primary TAP, and 43 control patients. Veau classification was similar between patients receiving TAP (Fischer’s exact test p=.139), but Veau II cleft were associated with receiving TAP compared to non-TAP Furlow palatoplasty (Fischer’s exact test p=.01). Overall complication rates were similar between patients who received TAP and non-TAP Furlow palatoplasty (?2=.48, p=.49). However, TAP displayed decreased odds of developing a post-operative fistula (OR .16, ?2=11.35, p=.003). Of patients who had pre- and postoperative PWSS, two patients (one TAP, one non-TAP) had postoperative documentation of VPI (PWSS ?7). Both TAP and non-TAP Furlow palatoplasty were associated with adequate post-operative PWSS scores (median 15 vs 4, p=.002).
Conclusions: Tissue augmenting palatoplasty is effective at treating cleft palate, specifically reducing VPI without notable change in complication rate. Although flap selection and overall technique can be nuanced, TAP is an important tool for cleft palate repair.
