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

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Romero-Narvaez et al

Figure 1. PRISMA fl ow diagram.

layer, 10,35 as a

10 as a tunneled

sample of a major craniofacial center, and as the authors use BFP routinely in their primary palate repair, it was decided to include this report in our review. We also found 10 comparative studies: 8 related to primary palatoplasty, one related to second ary palatoplasty, and one related to a donor-site outcome. There is a high level of heterogeneity between the studies, including study design, sample, inclusion criteria, the indica tion for and manner in which BFP is utilized, comparative material, palate repair surgical technique, outcomes, and length of follow-up (range 3 weeks-9 years). The overall level of evidence is low. Non-randomized studies have a high risk of bias according to MINORS, as well as the only RCT evaluated according to RoB2. Due to these limitations, we performed only a qualitative description of the studies included. The detailed description of the studies is shown in Tables 1 and 2. Risk of bias assessment is presented in Tables 3 and 4. Utility and Indications of Buccal Fat Pad In primary palatoplasty, BFP is used to cover exposed bone in lateral relaxing incisions in 431 (57.4%) patients, 2,23-28 as an intermediate layer at the hard-soft palate junction, 5,10,29-31 or to reinforce nasal tears or compromised mucosa in 226 (30.1%) patients. 5,27,32 It can also be split to serve both func tions 33 or cover all the denuded palatal bone deep to the oral fl aps 34 as described in 94 (12.5%) patients (Figure 2). In sec ondary cases, BFP is similarly used as an added intermediate

fi ller in the space of Ernst,

fl ap fi lling defects in oral or nasal layer, 35,36 and as a pedicled fl ap over the oral mucoperiosteal fl aps, fi lling defects in the oral layer. 19 In this last case, 3 of 29 patients required a second procedure to divide the pedicle. The indications for BFP vary. Some studies propose use in all primary palate repairs that require a relaxing incision, 23-26,28,30,34,37 while others restrict its use to “ wide or complicated ” clefts, 2,5,10,29 bilateral clefts, 27 or cases with nasal mucosal tears or closures under tension. 5,29,33 Different techniques for palate repair have been reported with BFP, including straight line, 10,26,27 Furlow, 2,5,21,23,30,32-35 push back, 25,30 Bardach, 2,5,28,37 and von Langenbeck palato plasty. 23,29 In secondary cases, BFP is used for oronasal fi stula repair 10,19,35 and palatal lengthening for velopharyngeal dysfunction. 35,36 Perioperative Complications There are no reports of a higher incidence of bleeding, infec tion, airway obstruction, partial dehiscence or fl ap necrosis in patients who underwent BFP. 2,10,23-25,27-29,33-35,37 Mucosalization The time for BFP mucosalization was reported to be 2-4 weeks , but this was described anecdotally in most studies. 2,19,24,28,33,34 Khan et al 26 addressed this outcome