{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T18:47:49Z","timestamp":1770144469911,"version":"3.49.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Maxillofac Plast Reconstr Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Velopharyngeal insufficiency (VPI) occurs in 5\u201336% of patients after primary palatorrhaphy for cleft palate, causing hypernasality and nasal emissions due to inadequate velopharyngeal closure. Although various surgical treatments are available, they may present limitations and potential risks, including obstructive sleep apnea. The buccinator myomucosal flap, with a reliable blood supply, provides a versatile option for VPI correction. In addition, it is associated with a low risk of complications, further supporting its safety and applicability in clinical practice. We report successful palatal lengthening using a modified bilateral buccinator myomucosal flap with a buccal fat flap in a 14-year-old patient with persistent VPI despite prior interventions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Case presentation<\/jats:title>\n            <jats:p>A 14-year-old female with a bilateral complete cleft lip and palate underwent primary cheiloplasty at 3\u00a0months and palatorrhaphy at 9\u00a0months of age. Despite 10\u00a0years of speech therapy and 4\u00a0years of speech aid use, hypernasality persisted. To address this, palatal lengthening was performed using bilateral buccinator myomucosal flaps combined with buccal fat flaps. At 1\u00a0month postoperatively, partial necrosis of the buccal fat grafts was observed but healed without further complications. At 8\u00a0months postoperatively, soft palate elongation exceeding 1\u00a0cm was achieved, and nasometric assessments demonstrated nasality reductions of 25.5 percentage points for high vowels (\/i\/, \/wi\/) and 19.5 percentage points at the sentence level. In the consonant accuracy evaluation, the patient\u2019s word-level accuracy increased from 72.09% preoperatively to 88.37% at 6\u00a0months postoperatively. These objective improvements correlated with subjective reports of improved speech and reduced vocal effort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>As seen in this case, the combined use of buccinator myomucosal and buccal fat flaps can be a viable surgical option for addressing VPI through soft palate lengthening. This approach can lead to improvement in hypernasality with minimal complications, and its efficacy may be further supported by future long-term follow-up studies involving larger patient populations.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s40902-025-00464-x","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T09:04:01Z","timestamp":1749459841000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical outcomes of using bilateral buccinator myomucosal flaps in cleft lip and palate patient with velopharyngeal insufficiency: case report"],"prefix":"10.1186","volume":"47","author":[{"given":"Tae Hyeong","family":"Park","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin-A","family":"Baek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung-O","family":"Ko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,9]]},"reference":[{"issue":"6","key":"464_CR1","first-page":"378","volume":"14","author":"E Silberstein","year":"2012","unstructured":"Silberstein E, Silberstein T, Elhanan E, Bar-Droma E, Bogdanov-Berezovsky A, Rosenberg L (2012) Epidemiology of cleft lip and palate among Jews and Bedouins in the Negev. IMAJ-Israel Medical Association Journal 14(6):378","journal-title":"IMAJ-Israel Medical Association Journal"},{"issue":"4","key":"464_CR2","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1093\/ejo\/20.4.407","volume":"20","author":"SR Turner","year":"1998","unstructured":"Turner SR, Rumsey N, Sandy J (1998) Psychological aspects of cleft lip and palate. The European Journal of Orthodontics 20(4):407\u2013415","journal-title":"The European Journal of Orthodontics"},{"key":"464_CR3","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/j.bjorl.2017.08.006","volume":"84","author":"R Denadai","year":"2018","unstructured":"Denadai R, Sabbag A, Amaral CER, Pereira Filho JC, Nagae MH, Amaral CAR (2018) Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and\/or lip. Braz J Otorhinolaryngol 84:697\u2013707","journal-title":"Braz J Otorhinolaryngol"},{"issue":"2","key":"464_CR4","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/j.cps.2013.12.004","volume":"41","author":"AW Kummer","year":"2014","unstructured":"Kummer AW (2014) Speech evaluation for patients with cleft palate. Clin Plast Surg 41(2):241\u2013251","journal-title":"Clin Plast Surg"},{"key":"464_CR5","unstructured":"Woo AS, editor. Velopharyngeal dysfunction. Seminars in plastic surgery; 2012: Thieme Medical Publishers"},{"key":"464_CR6","unstructured":"Raju H, Padmanabhan TV, Narayan A (2009) Effect of a palatal lift prosthesis in individuals with velopharyngeal incompetence. International Journal of Prosthodontics 22(6)"},{"key":"464_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40902-021-00315-5","volume":"43","author":"D-C Kang","year":"2021","unstructured":"Kang D-C, Park J-H, Seok H, Baek J-A, Kim D-W, Ko S-O (2021) Speech-aid prosthesis in velopharyngeal incompetency patient with cleft palate: can speech aids be applicable for adult patient? Maxillofacial Plastic and Reconstructive Surgery 43:1\u20137","journal-title":"Maxillofacial Plastic and Reconstructive Surgery"},{"issue":"3","key":"464_CR8","doi-asserted-by":"publisher","first-page":"163","DOI":"10.7181\/acfs.2018.02082","volume":"19","author":"SM Nam","year":"2018","unstructured":"Nam SM (2018) Surgical treatment of velopharyngeal insufficiency. Archives of Craniofacial Surgery 19(3):163","journal-title":"Archives of Craniofacial Surgery"},{"issue":"2","key":"464_CR9","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.cps.2013.12.010","volume":"41","author":"MS Gart","year":"2014","unstructured":"Gart MS, Gosain AK (2014) Surgical management of velopharyngeal insufficiency. Clin Plast Surg 41(2):253\u2013270","journal-title":"Clin Plast Surg"},{"issue":"7","key":"464_CR10","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1016\/j.bjps.2012.01.020","volume":"65","author":"J Collins","year":"2012","unstructured":"Collins J, Cheung K, Farrokhyar F, Strumas N (2012) Pharyngeal flap versus sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency: a meta-analysis. J Plast Reconstr Aesthet Surg 65(7):864\u2013868","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"2","key":"464_CR11","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1097\/00006534-198908000-00010","volume":"84","author":"AR Bozola","year":"1989","unstructured":"Bozola AR, Gasques JAL, Carriquiry CE, de Oliveira MC (1989) The buccinator musculomucosal flap: anatomic study and clinical application. Plast Reconstr Surg 84(2):250\u2013257","journal-title":"Plast Reconstr Surg"},{"issue":"2","key":"464_CR12","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1017\/S0022215107008353","volume":"122","author":"A Van Lierop","year":"2008","unstructured":"Van Lierop A, Fagan J (2008) Buccinator myomucosal flap: clinical results and review of anatomy, surgical technique and applications. J Laryngol Otol 122(2):181\u2013187","journal-title":"J Laryngol Otol"},{"issue":"5","key":"464_CR13","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1597\/11-211","volume":"50","author":"G Hens","year":"2013","unstructured":"Hens G, Sell D, Pinkstone M, Birch M, Hay N, Sommerlad B et al (2013) Palate lengthening by buccinator myomucosal flaps for velopharyngeal insufficiency. Cleft Palate Craniofac J 50(5):84\u201391","journal-title":"Cleft Palate Craniofac J"},{"issue":"1","key":"464_CR14","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1097\/00006534-199907000-00008","volume":"104","author":"Z Zhao","year":"1999","unstructured":"Zhao Z, Li S, Yan Y, Li Y, Yang M, Mu L et al (1999) New buccinator myomucosal island flap: anatomic study and clinical application. Plast Reconstr Surg 104(1):55\u201364","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"464_CR15","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.asjsur.2015.10.010","volume":"40","author":"A Rahpeyma","year":"2017","unstructured":"Rahpeyma A, Khajehahmadi S (2017) Donor site morbidity in buccinator-based myomucosal flaps: a retrospective study. Asian J Surg 40(3):210\u2013214","journal-title":"Asian J Surg"},{"issue":"8","key":"464_CR16","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000005200","volume":"11","author":"KM Termanini","year":"2023","unstructured":"Termanini KM, Lentskevich MA, Moradian S, Gosain AK (2023) Single-stage palatal lengthening using modified buccinator myomucosal and buccal fat flaps. Plastic and Reconstructive Surgery-Global Open 11(8):e5200","journal-title":"Plastic and Reconstructive Surgery-Global Open"},{"issue":"2","key":"464_CR17","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1597\/02-124","volume":"41","author":"IT Jackson","year":"2004","unstructured":"Jackson IT, Moreira-Gonzalez AA, Rogers A, Beal BJ (2004) The buccal flap\u2014a useful technique in cleft palate repair? Cleft Palate Craniofac J 41(2):144\u2013151","journal-title":"Cleft Palate Craniofac J"},{"issue":"11","key":"464_CR18","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1016\/j.bjps.2017.06.029","volume":"70","author":"R Denadai","year":"2017","unstructured":"Denadai R, Sabbag A, Raposo-Amaral CE, Filho P, JC, Nagae MH, Raposo-Amaral CA, (2017) Bilateral buccinator myomucosal flap outcomes in nonsyndromic patients with repaired cleft palate and velopharyngeal insufficiency. J Plast Reconstr Aesthet Surg 70(11):1598\u20131607","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"4","key":"464_CR19","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1097\/SAP.0000000000003809","volume":"92","author":"TM Monte","year":"2024","unstructured":"Monte TM, Raposo-Amaral CA, Sabbag A, Gil A, Menezes PT, Raposo-Amaral CE (2024) Speech outcomes after palatal lengthening via double opposing buccinator myomucosal flaps. Ann Plast Surg 92(4):395\u2013400","journal-title":"Ann Plast Surg"},{"issue":"4","key":"464_CR20","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1097\/PRS.0000000000010443","volume":"152","author":"SN Chiang","year":"2023","unstructured":"Chiang SN, Fotouhi AR, Grames LM, Skolnick GB, Snyder-Warwick AK, Patel KB (2023) Buccal myomucosal flap repair for velopharyngeal dysfunction. Plast Reconstr Surg 152(4):842\u2013850","journal-title":"Plast Reconstr Surg"}],"container-title":["Maxillofacial Plastic and Reconstructive Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40902-025-00464-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40902-025-00464-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40902-025-00464-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T09:04:03Z","timestamp":1749459843000},"score":1,"resource":{"primary":{"URL":"https:\/\/jkamprs.springeropen.com\/articles\/10.1186\/s40902-025-00464-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,9]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["464"],"URL":"https:\/\/doi.org\/10.1186\/s40902-025-00464-x","relation":{},"ISSN":["2288-8586"],"issn-type":[{"value":"2288-8586","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,9]]},"assertion":[{"value":"24 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from parent of patient for the publication of this case report and accompanying images.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"13"}}