Pharyngeal Airway Volumes in Adults With Cleft Palate: Comparing an Anatomic Cleft Restoration Philosophy “Buccal Flap” Palatoplasty and Non-Cleft Controls

Objective The purpose of this study was to compare pharyngeal airway volume between two groups: (1) Individuals with Veau 3 or 4 clefts repaired using a buccal flap-based palatoplasty technique, and (2) age-matched individuals without cleft palate. Design Observational, prospective. Setting Two regional hospitals and an academic institution. Participants 30 adult males were included in the study: 15 individuals with complete Veau 3 or 4 clefts repaired with double-opposing Z-plasty and buccal flaps (DOZP + BF) during primary palatoplasty and 15 age-matched controls without cleft palate. Individuals with a history of secondary speech surgery, orthognathic surgery, or other interventions affecting the nasopharyngeal airway were excluded. Interventions All participants’ anatomy was visualized using MRI. Main Outcome Measures Five pharyngeal airway anatomical measures. Results No statistically significant differences between groups were observed for nasopharyngeal, velopharyngeal, hypopharyngeal, or total airway volumes. Individuals with cleft palate repaired with DOZP + BF demonstrated significantly larger oropharyngeal volumes compared with controls ( P < 0.001). Conclusion This study suggests that adult males with Veau 3 or 4 clefts repaired using DOZP + BF technique, who have no history of secondary speech surgery or orthognathic surgery, demonstrate airway volumetric measurements that are largely comparable to those of age-matched individuals without cleft palate. The exception is the oropharyngeal airway, which was slightly larger in the cleft group compared with controls. Future research is needed to further evaluate the functional implications of these anatomical differences and to compare outcomes across different surgical approaches.