Oral Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Buccal Artery Myomucosal Flaps in the Treatment of Velopharyngeal Insufficiency – the South Island Experience (1725)

Raymond Phang 1 , Nicholas Brougham 1 , Michelle Shand 1 , Nicki Mason 1 , Sarah Gardiner 1 , Kirk Williams 1
  1. Regional Centre for Plastic, Reconstructive and Hand Surgery, Christchurch Hospital, Te Whatu Ora, Christchurch, New Zealand

Background 
Velopharyngeal insufficiency (VPI) can be detrimental to a child’s quality of life. Several different surgical management options have been described and, within our unit, palatoplasty with levator veli repositioning and buccal artery myomucosal (BAMM) flap reconstruction has been advocated for as an effective treatment of choice. The aim of this study was to assess the speech outcomes and rate of complications in the patients who underwent BAMM flap reconstruction for VPI at Christchurch Hospital, New Zealand. 
 
Methods 
A single-centre retrospective review was undertaken over a seven-year period from the 1st of January 2018 to the 1st of January 2025. Utilising local category surgery codes, patients treated for VPI with BAMM flap reconstruction by the Plastic Surgery Cleft Service were identified.  
 
Results 
Eleven cases of BAMM flaps were identified over the study period. Eight patients were male (70%) and three were female (30%) with a median age at the time of surgery of seven years old (range; 2 – 16 years old). Patients could identify with more than one ethnicity and included two New Zealand Māori (20%), eight New Zealand European (70%), three Other European (30%), two South East Asian (20%) and one Latin American (10%). Six patients were associated with congenital syndromes (55%). Speech outcomes pre-operatively and post-operatively were evaluated including clinical signs of VPI, intelligibility and acceptability. Speech improvements were documented in nine patients (80%). The remaining two patients had not yet had follow-up by the Cleft Service. There were no cases of flap failure over a median follow-up time of ten months.  
 
Conclusion 
BAMM flap reconstruction for VPI has shown promising results in this single-centre retrospective review. Further research directly evaluating the efficacy of the different established surgical techniques is now required to develop an effective national healthcare delivery framework to address the challenging problem of VPI.