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 Table of Contents  
LETTER TO THE EDITOR
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 67

Management of velopharyngeal insufficiency: The evolution of care and the current state of the art


Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India

Date of Submission07-Sep-2019
Date of Acceptance15-Sep-2019
Date of Web Publication20-Jan-2020

Correspondence Address:
Dr. R Thatte Mukund
Room No. 215, 2nd Floor, New Wing, Bombay Hospital and Institute of Medical Sciences, Marine Lines, Mumbai - 400 052, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jclpca.jclpca_24_19

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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 Jul 10];7:67. Available from: http://www.jclpca.org/text.asp?2020/7/1/67/276200



Sir,

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.[1] 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.[2] 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[3] and Kaplan[4] described the use of buccal mucosal flap for cleft palate repair in 1962 and 1975, respectively.

Maeda et al.[5] through their landmark paper in 1987, Freedlander and Jackson through their paper in 1989,[6] Chen and Zhong,[7] and Van Lierop and Fagan[8] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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.  Back to cited text no. 1
  [Full text]  
2.
Mukherji MM. Cheek flap for short palates. Cleft Palate J 1969;6:415-20.  Back to cited text no. 2
    
3.
Millard DR Jr. Wide and/or short cleft palate. Plast Reconstr Surg Transplant Bull 1962;29:40-57.  Back to cited text no. 3
    
4.
Kaplan EN. Soft palate repair by levator muscle reconstruction and a buccal mucosal flap. Plast Reconstr Surg 1975;56:129-36.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    
6.
Freedlander E, Jackson IT. The fate of buccal mucosal flaps in primary palatal repair. Cleft Palate J 1989;26:110-2.  Back to cited text no. 6
    
7.
Chen GF, Zhong LP. A bilateral musculomucosal buccal flap method for cleft palate surgery. J Oral Maxillofac Surg 2003;61:1399-404.  Back to cited text no. 7
    
8.
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.  Back to cited text no. 8
    




 

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