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

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Romero-Narvaez et al

Donor Site Morbidity BFP resection has recently gained signi fi cant interest and pop ularity in facial esthetics. Despite short-term subjective improvement in facial contour, there is a lack of data about long-term outcomes, 74,75 along with questions about how BFP resection in fl uences facial ageing. Cheek hollowing, earlier deepening of the nasojugal fold, lack of the support of the medial cheek and middle cheek fat, are among the effects attributable to volume loss of the buccal fat pad. As such, there are concerns of short-term and long-term donor site deformities and facial asymmetries from BFP utilization in cleft repair. Interestingly, Bennett et al did not fi nd signi fi cant differences in volume between both cheeks in 24 patients who have underwent unilateral BFP fl aps for cleft repair after a mean follow-up of 55 months. 39 They similarly did not fi nd any signi fi cant subjective differences in a blinded evaluation of clinical photographs by surgery residents. Although the results of this study are encouraging, it has a relatively short period of follow-up, considering that primary palatoplasty is usually performed around 1 year of age and most secondary repairs are done in childhood. Most surgeons who use BFP in a routine basis argue that the volume of BFP used for recon structive purposes is not enough to impair facial contour and that up to two-thirds of the BFP remains in the cheek, protecting against visible deformation. 2,39,46 Some studies also have shown that the BFP body in children has a different distribution of the fat when compared to adult BFP 76 and that the average BFP volume almost doubles between childhood and adulthood. 77 Understanding how all these factors in fl uence long-term out comes is a pending task and requires further investigation. Limitations Beyond limitations in individual studies, there are a few limita tions of this speci fi c systematic review protocol that are notable. First, only articles written or translated to the English language were included in this systematic review. While some systematic reviews in the cleft literature incorporate non-English refer ences, 78,79 it is not a universal practice, 40 and non-English ref erences tend to be a minority of articles that meet inclusion criteria. 78 Second, a small sample size of fi ve subjects was uti lized for inclusion criteria. This lower cutoff was chosen to incorporate more articles discussing the utility of BFP tissue in primary and secondary cleft palatoplasty as the technique is relatively new. In this particular systematic review, the majority of articles were published in the last 10 years. If a more stringent exclusion criterion was selected such as 10 or more subjects, then fi ve case studies would have been eliminated. This adjust ment may decrease the heterogeneity and bias found in this sys tematic review, but it would also diminish the already limited published evidence on BFP use in cleft palatoplasty. Conclusions BFP has been used in a variety of manners in primary and sec ondary cleft palate repair. There is some encouraging evidence

regarding its role in fi stula prevention and management, as well as a favorable impact in reducing maxillary growth restriction. Use of BFP in palate repair appears to be associated with low rates of donor site deformity and postoperative complications. However, there is a high heterogeneity among studies and overall low quality of evidence. Thus, more high-quality research with long-term follow-up in the utilization of the buccal fat pad for primary and secondary palatoplasty is warranted. Acknowledgements We would like to thank Dr. Ibrahim Khansa for providing valuable insights during the review process. Declaration of Con fl icting Interests The authors declared no potential con fl icts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors received no fi nancial support for the research, authorship, and/or publication of this article. ORCID iDs Carolina Romero-Narvaez https://orcid.org/0000-0003-0694-4910 Lawrence O. Lin https://orcid.org/0000-0002-6242-8219 References 1. Choi KJ, Wlodarczyk JR, Nagengast ES, et al. The likelihood of orthognathic surgery after orofacial cleft repair. J Craniofac Surg . 2021;32(3):902-906. 2. Levi B, Kasten SJ, Buchman SR. Utilization of the buccal fat pad fl ap for congenital cleft palate repair. Plast Reconstr Surg . 2009;123(3):1018-1021. 3. Reddy RR, Gosla Reddy S, Vaidhyanathan A, Bergé SJ, Kuijpers-Jagtman AM. Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review. J Cranio-Maxillofac Surg . 2017;45(6):995-1003. 4. Lo CC, Denadai R, Lin HH, et al. Favorable transverse maxillary development after covering the lateral raw surfaces with buccal fat fl aps in modi fi ed Furlow palatoplasty: a three-dimensional imaging-assisted long-term comparative outcome study. Plast Reconstr Surg . 2022;150(2):396e-405e. 5. Thurston TE, Vargo J, Bennett K, Vercler C, Kasten S, Buchman S. Filling the void: use of the interpositional buccal fat pad to decrease palatal contraction and fi stula formation. FACE . 2020;1(1):33-40. 6. Rautio J, Andersen M, Bolund S, et al. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 2. Surgical results. J Plast Surg Hand Surg . 2017;51(1):14-20. 7. Tse RW, Siebold B. Cleft palate repair: description of an approach, its evolution, and analysis of postoperative fi stulas. Plast Reconstr Surg . 2018;141(5):1201-1214. Supplemental Material Supplemental material for this article is available online.