The Use of Fixed and Removable Bite Blocks in Bilateral Buccinator Flap Surgery for Velopharyngeal Insufficiency

<i>Objective</i>To ascertain the current practice in the United Kingdom with regard to the use of bite blocks and the division of the pedicles in buccinator flap surgery for velopharyngeal insufficiency. To compare the outcomes of fixed and removable bite blocks in buccinator flap surgery, in terms of the incidence of pedicle injury and patient experience.<i>Design</i>Survey of cleft surgeons in the United Kingdom on their use of bite blocks and division of the pedicles. Retrospective cohort review of consecutive patients that underwent buccinator flap surgery at Salisbury District Hospital between January 1, 2021, and December 31, 2022, comparing the use of fixed and removable bite blocks. Survey of patients who had bite blocks fitted to understand the patient and family experience.<i>Results</i>Cleft consultants from the United Kingdom and Ireland responded: half (11 of 22) reported using bite blocks and half reported routinely dividing the pedicles, most commonly at 4 to 6 weeks after surgery. In our cohort (19 patients), fixed bite blocks had a higher incidence of pedicle injury (33%) and difficulty eating (78%) than removable bite blocks (20% and 20%, respectively). Generally, parents/patients tolerated the presence of bite blocks and were often unaware of pedicle injury, even in cases of repeated severe biting.<i>Conclusion</i>There is variation in the current use of bite blocks and pedicle division following buccinator flap surgery in the United Kingdom. In compliant patients, removable bite blocks may be associated with lower complication rates but neither fixed nor removable bite blocks compromise flap integrity.