xRead - Treatment of Cleft Lip and Cleft Palate (May 2025)

Original Article

The Cleft Palate Craniofacial Journal 1 ‐ 16 © 2023, American Cleft Palate

Buccal Fat Pad in Primary and Secondary Cleft Palate Repair: A Systematic Review of the Literature

Craniofacial Association Article reuse guidelines:

sagepub.com/journals-permissions DOI: 10.1177/10556656231206238 journals.sagepub.com/home/cpc

Carolina Romero-Narvaez, MD 1 and Richard E. Kirschner, MD 1,3

, Lawrence O. Lin, MD 2

,

Abstract Objective: To review the evidence supporting the use of buccal fat pad (BFP) in primary and secondary cleft palate repair and its short- and long- term clinical outcomes. Design: Systematic review conducted by 2 independent reviewers following PRISMA guidelines. Setting: None Participants: Articles were identi fi ed from three databases (Pubmed/Medline, Embase and Web of Science). Search terms included “ cleft palate ” , “ palatoplasty ” , “ palate repair ” , “ buccal fat pad ” . Interventions: Use of BFP in primary and secondary cleft palatoplasty. Main Outcome Measures: Primary outcomes were immediate postoperative complications, postoperative fi stula, and maxillary growth. Secondary outcomes were palatal length, speech, and donor site morbidity. Results: Ninety-one reports were retrieved after excluding duplicates. Twenty-three studies were included (13 case series and 10 comparative studies). Overall level of evidence was low. Randomized and non-randomized studies had a high risk of bias. In pri mary palatoplasty, BFP was more frequently used fi lling lateral relaxing incisions(57.4%), or in the hard-soft palate junction and covering mucosal defects(30.1%). In these patients, post operative fi stula incidence was 2.8%. Two studies found wider transverse maxillary dimensions after BFP use. No higher incidence of bleeding, infection, dehiscence, or fl ap necrosis was reported. In sec ondary palatoplasty, no recurrent fi stulas were reported for patients undergoing BFP for fi stula repair. Conclusions: BFP appears to be associated with a favorable impact in fi stula prevention and management, as well as in transverse maxillary growth. However, there is a high heterogeneity among studies, high risk of bias and overall low quality of evidence. More high-quality research with long-term follow-up is warranted.

Keywords cleft palate, palatoplasty, fi stula, facial growth, surgical complications

Introduction Palatoplasty is a necessary surgery for patients with a cleft palate in order to reconstruct the altered intraoral anatomy and achieve normal speech. However, it remains a challenge to achieve a balance between optimal velopharyngeal function and optimal facial growth. 1 Congenital tissue de fi ciency demands extensive mobilization of mucosal layers to close the cleft, creating dead space between oral and nasal layers and exposing bone due to the use of lateral relaxing incisions. Healing by secondary intention can reduce maxillary growth, 2-4 and lead to mispositioning of the levator veli palatini and short ening of the soft palate. 5 Failure to achieve a tension-free closure may lead to dehiscence or fi stula, with reported rates of such varying from 0%-78%. 6-8

Many adjunctive palatoplasty techniques, such as use of the buccal fat pad (BFP), have been described. BFP is a specialized adipose tissue localized in the masticatory space. 9,10 It was

1 Plastic and Reconstructive Surgery Service, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru 2 Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA 3 Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA Corresponding Author: Carolina Romero-Narvaez, Plastic and Reconstructive Surgery Service, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru. Email: carol.jrn@gmail.com

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