Investigating the Effectiveness of Buccal Flap for Velopharyngeal Insufficiency: A Systematic Review Article

Abstract

Background: Velopharyngeal insufficiency (VPI) is a failure of the sphincter mechanism, causing speech patterns like hypernasality and decreased intelligibility. Causes include structural, neurologic, and mechanical issues. Treatment options include non-surgical and surgical interventions, but complications can arise. A new approach using the buccal flap (BF) has been suggested for palatal length augmentation. This systematic review assessed speech outcomes after BF palatal lengthening. Methods: A thorough investigation was conducted by methodically reviewing numerous databases, including PubMed, Scopus, Web of Science, and Embase, until December 2024. The goal of our analysis was to find studies that assess the short- and long-term efficacy of BF on speech outcomes on patients with VPI. We used the NIH Quality Assessment Tool to assess the quality of the evidence, ensuring the dependability of the results reached during these investigations. Results: This systematic review identified 23 studies (total sample size of 995) that assessed the speech outcomes of BF on VPI. The BF significantly improves speech outcomes in patients with VPI. Hypernasality improved significantly post-surgery, with outcomes measured using different scales and methods, including both subjective and objective tools. Benefits were observed within three months postoperatively, with sustained benefits up to 15 months in several studies. Speech intelligibility also improved notably, with mean differences up to 1.09 (p < 0.001). Reductions in audible nasal air emissions were observed, though some variability was noted across studies. Secondary outcomes, including better velopharyngeal closure and decreased facial grimacing, further highlight its efficacy. However, inconsistent findings for nasal turbulence and limited long-term data suggest that benefits may plateau over time. These findings support the BF as an effective intervention, though further research is needed on extended outcomes. Conclusions: BF is an effective surgical intervention for VPI, significantly improving hypernasality, speech intelligibility, and audible nasal air emissions. While benefits are evident across diverse populations, long-term outcomes and secondary features, such as nasal turbulence, show variability, emphasizing the need for individualized approaches and continued follow-up. This technique offers a reliable option for functional and speech rehabilitation, though further research is needed to optimize its long-term efficacy and broader outcomes.