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

11

Romero-Narvaez et al

Figure 2. Buccal fat pad placement in primary palatoplasty.

than cleft width or type, 43 but other reports have shown mixed results. 7,30,37,44,45 Many of the reports analyzed in this system atic review claim that adding BFP in cases with wide clefts improves results and diminishes rates of fi stula formation. Thanapaisal et al 37 and Kim et al 30 found a signi fi cant associ ation between fi stula formation and cleft width and ratio of cleft width, respectively. These studies also found a protective effect of the BFP, even though they utilized it in a different manner – covering lateral relaxing incisions in the fi rst case and inset at the hard-soft palate junction in the latter. Others have also utilized BFP for wide clefts 2,10,29 or in cases of mucosal tears or residual defects. 2,5,27,29,32,36 In our review, all comparative studies that measured fi stula rates reported lower rates in patients undergoing palotoplasty with BFP, including primary 25,30,37 and secondary 36 palatoplasties. These studies found a larger median fi stula size and higher rates of needing fi stula closure in non-BFP groups. Close proximity to the palate and almost universal availabil ity could provide an attractive alternative to alloplastic materi als in cases of tissue de fi ciency, especially in low-resources settings. However, one important drawback is the lack of an algorithm of when to use BFP. Adjectives as “ wide ” or “ complicated ” cleft palate have been mentioned to justify BFP use in cleft palate repair but without objective de fi nitions. Furthermore, there is a high variability in palatoplasty tech niques and in utilization of the BFP, thus precluding a more robust analysis. The evidence suggests that the use of buccal fat during primary palatoplasty may decrease fi stula rates; however, longer-term studies that control for palatoplasty tech nique, cleft anatomy, and cleft dimensions are necessary to draw a more de fi nitive conclusion.

Immediate Postoperative Outcomes One of the major concerns about BFP use is its potential for perioperative infection or other complications. There is no indication that patients who undergo BFP reconstruction have higher rates of complications such as bleeding, infection, airway obstruction, partial dehiscence, or fl ap necrosis. Additionally, mucosalization of the BFP raw surface such as during placement in palatoplasty relaxing incisions occurs rel atively quickly over 2-4 weeks and is marginally faster in com parison to Surgicel placement in the relaxing incisions (full mucosalization by POD21 vs. POD28). Fistula One of the most frequently reported outcomes with BFP use is fi stula formation. Reports of fi stula rates following palate repair are variable, ranging from 0 to 78% 8,40 with an overall incidence of postoperative fi stula of 8.6% (95%CI [6.4-11-1%]), according to one meta-analysis. 40 Approximately thirty risk factors associated with this outcome have been studied such as timing of the surgery, type and width of the cleft, surgery techniques and surgeon ’ s experience. 8,40,41 Salimi et al found that the most frequently studied risk determinants did not present consistent patterns across different studies, other than a high heterogeneity and a general low quality of evidence. 8 In the case of association of cleft width and type, the variety of measurement methods makes comparison problematic. 8,41,42 Some authors have hypothesized that tissue de fi ciency present, measured by the relation between the width of the cleft and the width of the palatal shelves, is a more important factor in fi stula formation