Utilization of the Buccal Fat Pad Flap for Congenital Cleft Palate Repair

Abstract

Clefting of the palate is one of the most common deformities in the craniofacial skeleton, with more than 6800 children born with a cleft palate each year in the United States.' Most of these children are referred to a surgeon for definitive repair; however, palatal fistulas and transverse growth restriction remain a significant problem for clinicians regardless of the center and type of repair. 2,3 The main cause of these complications is a lack of tissue creating tension at the closure, as well as healing by secondary intention and subsequent growth restriction. To address these concerns, we describe a new technique of cleft palate repair using pedicled buccal fat pad flaps as an added tissue layer. Previous buccal fat pad uses include closure after tumor excision, 4-6 dentoalveolar defects, 7 oroantral fistulas, 8-10 and palatal defects. 11,12 We describe a new use of the buccal fat pad flap: cleft palate repair coupled with pedicled buccal fat pad flaps to cover areas of exposed bone of the hard palate as well as midline areas of high tension. We believe this technique may decrease scar contraction and subsequent transverse maxillary growth restriction induced by the lateral hard palatal tissue defect, as well as buttress areas where fistula formation is most common. Technically, minimal time, skill, and dissection are needed to harvest this robust flap, and we think cleft surgeons will find this useful for challenging cleft palate and palatal fistula repairs.