|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 67
Management of velopharyngeal insufficiency: The evolution of care and the current state of the art
R Shah Harsh, B Takwale Anupam, R Thatte Mukund
Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
|Date of Submission||07-Sep-2019|
|Date of Acceptance||15-Sep-2019|
|Date of Web Publication||20-Jan-2020|
Dr. R Thatte Mukund
Room No. 215, 2nd Floor, New Wing, Bombay Hospital and Institute of Medical Sciences, Marine Lines, Mumbai - 400 052, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Harsh R S, Anupam B T, Mukund R T. Management of velopharyngeal insufficiency: The evolution of care and the current state of the art. J Cleft Lip Palate Craniofac Anomal 2020;7:67
|How to cite this URL:|
Harsh R S, Anupam B T, Mukund R T. Management of velopharyngeal insufficiency: The evolution of care and the current state of the art. J Cleft Lip Palate Craniofac Anomal [serial online] 2020 [cited 2020 Apr 10];7:67. Available from: http://www.jclpca.org/text.asp?2020/7/1/67/276200
Kummer has indeed given a splendid write-up on the topic “Velopharyngeal insufficiency” in the July–December 2019 issue of the Journal of Cleft Lip Palate and Craniofacial Anomalies. The article covers every aspect, starting from the history to the management, of the often less understood dysfunction, velopharyngeal incompetence, making it a quick revision for every cleft surgeon.
Of the various treatment options available, the author mentions the utility of a “relatively new procedure,” viz., buccal (buccinator myomucosal) flap to lengthen the palate.
Respectfully, we would like to say that buccal flap has caught attention of cleft surgeons ever since its first description in the 20th century. The credit of the first description of the buccal mucosal flap goes to Mukherji in 1969. His pioneer paper described the methodology and usefulness of the buccal flap in lengthening of the palate as well as lengthening of the nasal palate. He opined that effective length of the soft palate depends on the depth of the nasopharynx. A deep nasopharynx can effectively shorten soft palate of adequate length. His rationale for the use of buccal flap was the possibility to further lengthen the soft palate and to avoid surgeries such as pharyngeal flap in small children.
Millard and Kaplan described the use of buccal mucosal flap for cleft palate repair in 1962 and 1975, respectively.
Maeda et al. through their landmark paper in 1987, Freedlander and Jackson through their paper in 1989, Chen and Zhong, and Van Lierop and Fagan have all discussed the buccal flap and its use in the cleft palate repair for similar purposes.
We feel that the buccal flap has been practiced for decades and is not a recent innovation. Once again, we thank the author for the excellent paper.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Kummer AW. Management of velopharyngeal insufficiency: The evolution of care and the current state of the art. J Cleft Lip Palate Craniofac Anomal 2019;6:65-72. [Full text]
Mukherji MM. Cheek flap for short palates. Cleft Palate J 1969;6:415-20.
Millard DR Jr. Wide and/or short cleft palate. Plast Reconstr Surg Transplant Bull 1962;29:40-57.
Kaplan EN. Soft palate repair by levator muscle reconstruction and a buccal mucosal flap. Plast Reconstr Surg 1975;56:129-36.
Maeda K, Ojimi H, Utsugi R, Ando S. A T-shaped musculomucosal buccal flap method for cleft palate surgery. Plast Reconstr Surg 1987;79:888-96.
Freedlander E, Jackson IT. The fate of buccal mucosal flaps in primary palatal repair. Cleft Palate J 1989;26:110-2.
Chen GF, Zhong LP. A bilateral musculomucosal buccal flap method for cleft palate surgery. J Oral Maxillofac Surg 2003;61:1399-404.
Van Lierop AC, Fagan JJ. Buccinator myomucosal flap: Clinical results and review of anatomy, surgical technique and applications. J Laryngol Otol 2008;122:181-7.