편측 협근 근점막 피판을 이용한 구개 연장술: 일차 구개열 수술 후 구개 인두 부전증 환아에서의 증례 보고

Abstract

Velopharyngeal insufficiency (VPI) following primary cleft palate surgery presents a challenge in the management of patients with cleft palate for oral and maxillofacial surgeons. Surgical methods that lengthen the palate for the treatment of VPI, such as the buccinator myomucosal flap (BMMF) technique, offer a more physiological and anatomical reconstruction compared to pharyngoplasty. The BMMF technique is considered promising due to its relatively simple procedure, rich blood supply, similar properties to the recipient tissue, low donor site morbidity, and fewer postoperative complications. In this case, despite undergoing a primary palatoplasty at 12 months, the child continued to have nasal drainage and poor speech development. An intravelar veloplasty was performed at 32 months, which successfully closed the oro-nasal fistula and resolved the associated symptoms. However, due to persistent hypernasality, a unilateral posterior-based BMMF was chosen to further extend the soft palate. Although long-term follow-up results have not yet been obtained, the successful increase in soft palate length through BMMF suggests that further improvement may be achieved with concurrent speech therapy.