Palatoplasty Technique Research Articles

D75. A Comparison of Vomer Flap Palatoplasty Techniques on Fistula Repair in Bilateral Cleft Lip and Palate: A Single Center 25-year Experience

PURPOSE: In bilateral cleft lip and palate (BCLP) patients, vomer flaps can facilitate the closure of larger defects by adding width to the nasal layer. This study aims to assess the effect of vomer flaps on velopharyngeal insufficiency (VPI). METHODS: A retrospective review of patients diagnosed with cleft lip and/or palate(CL/P)who underwent palatoplasty at an urban academic children’s hospital between 1997-2022 was completed. Surgical technique, postoperative management, and surgical VPI rates were collected. Statistical analysis was performed with RStudio 4.2.1. RESULTS: Upon review, 1,552 patients were identified with CL/P, of which 191 (12.3%) had BCLP with a VPI rate of 18.3%. Among patients with BCLP, 88.3% underwent palatoplasty with vomer flap. There were lower rates of postoperative VPI requiring surgery in the vomer flap cohort than in patients without vomer flap (13.2% vs. 57.1%, p=0.012), however patients with vomer flaps were more frequently managed with speech therapy alone (47.2% vs. 28.6%, p=0.034). Logistic regression demonstrates that vomer flaps were the only significant contributor to increased rates of speech surgery. Overall follow-up time was 8.9±4.5 years. CONCLUSION: These results associate vomer flaps with decreased rates of surgical VPI and higher rates of speech interventions. This suggests VPI following palatoplasty augmented with vomer flap may be less severe. Use of vomer flaps to restore nasal mucosa continuity and reconstruct the velum should be considered to minimize risk of severe VPI requiring surgery.

Sommerlad–Furlow modified palatoplasty: A retrospective study

The purpose of this study was to introduce the surgical process of Sommerlad–Furlow modified (S–F) palatoplasty and compare its surgical and functional outcomes with conventional Sommerlad (S) palatoplasty.Patients with non-syndromic cleft palate who had undergone either S–F palatoplasty or S palatoplasty were retrospectively reviewed. Data on the outcomes of velopharyngeal function and postsurgical palatal fistula incidence were collected for all patients. Data for preselected factors, including gender, age at palatoplasty, and cleft type, were also collected. Chi-square tests were conducted.1254 patients were included. The postsurgical velopharyngeal competence (VPC) rate after S–F palatoplasty was significantly higher than after S palatoplasty (total, 70.5% vs 57.9%, p < 0.0001; age ≤ 1, 87.0% vs 69.2%, p < 0.0001; 1 < age ≤ 2, 78.3% vs 69.3%, p = 0.0479). With regard to different types of cleft palate, the postsurgical VPC rates after S–F palatoplasty were all significantly higher than for S palatoplasty in all patients younger than 2 years of age (complete cleft palate, 78.7% vs 62.4%, p = 0.0016; hard and soft palate cleft, 84.4% vs 74.8%, p = 0.0172; submucosal cleft and soft palate cleft, 96.6% vs 68.4%, p = 0.0114). The postoperative fistula rate after S–F palatoplasty was 4.3%.This modified palatoplasty technique provided adequate cleft palate closure, with satisfactory speech outcomes and low fistula rates, while older age at palatoplasty may affect the postsurgical outcomes. Within the limitations of the study it seems that the Sommerlad–Furlow modified technique is an option for cleft palate repair.

Comparison of velopharyngeal morphology of two palatoplasty techniques in patients with hard and soft cleft palate.

The study aims to compare the velopharyngeal morphology of hard and soft cleft palate (HSCP) patients after Furlow and Sommerlad palatoplasty. A total of 51 patients (20 cases in Furlow palatoplasty group, 16 cases in Sommerlad palatoplasty group and 15 normal children in the control group) were included in our study. Velopharyngeal function and speech outcomes of patients with HSCP who had either Furlow palatoplasty or Sommerlad palatoplasty for cleft palate repair were evaluated by perceptual speech assessment (PSA), lateral cephalometric radiographs and nasopharyngoscopy. To assess velopharyngeal morphology of patients treated with two techqiques, we analyzed measurements such as velar length, pharyngeal depth, and the Adequate ratio (the ratio of velar length to pharyngeal depth). Furthermore, skeletal landmarks including cranial base, cervical vertebrae, posterior nasal spine which were defined as the pharyngeal triangle were measured. Finally, the position of the point U relative to the pharyngeal triangle were compared. Velopharyngeal closure (VPC) rate in Furlow palatoplasty group accounted for 90%, while that in Sommerlad palatoplasty group was 81.3%. PSA of the former group was significantly better than that of the latter group (P < 0.05). Velar length, pharyngeal depth and the Adequate ratio (1.37 ± 0.14 vs. 1.41 ± 0.15) were comparable between the Furlow group and control group (P > 0.05), while Sommerlad group had a shorter velar length, deeper pharyngeal depth and a smaller Adequate ratio (1.20 ± 0.18) compared to the above two groups (P < 0.05). Furhermore, the point U of Sommerlad group in the pharyngeal triangle was higher than that of the other two groups. In the treatment modality of patients with HSCP, both Furlow palatoplasty and Sommerlad palatoplasty seem to be effective. Furlow palatoplasty appears to have velopharyngeal morphology similar to normal control group., while Sommerlad group shows a shorter velar length, deeper pharyngeal depth and a smaller Adequate ratio.

Predictors of Adverse Outcomes Following Cleft Palate Repair: An Analysis of Over 2500 Patients Using International Smile Train Data.

The objective of this study was to use data from Smile Train's global partner hospital network to identify patient characteristics that increase odds of fistula and postoperative speech outcomes. Multi-institution, retrospective review of Smile Train Express database. 1110 Smile Train partner hospitals. 2560 patients. N/A. Fistula occurrence, nasal emission, audible nasal emission with amplification (through a straw or tube) only, nasal rustle/turbulence, consistent nasal emission, consistent nasal emission due to velopharyngeal dysfunction, rating of resonance, rating of intelligibility, recommendation for further velopharyngeal dysfunction assessment, and follow-up velopharyngeal dysfunction surgery. The patients were 46.6% female and 27.5% underweight by WHO standards. Average age at palatoplasty was 24.7 ± 0.5 months and at speech assessment was 6.8 ± 0.1 years. Underweight patients had higher incidence of hypernasality and decreased speech intelligibility. Palatoplasty when under 6 months or over 18 months of age had higher rates of affected nasality, intelligibility, and fistula formation. The same findings were seen in Central/South American and African patients, in addition to increased velopharyngeal dysfunction and fistula surgery compared to Asian patients. Palatoplasty technique primarily involved one-stage midline repair. Age and nutrition status were significant predictors of speech outcomes and fistula occurrence following palatoplasty. Outcomes were also significantly impacted by location, demonstrating the need to cultivate longitudinal initiatives to reduce regional disparities. These results underscore the importance of Smile Train's continual expansion of accessible surgical intervention, nutritional support, and speech-language care.

Cleft palate: Part II – The concept and techniques

Cleft palate is the most common craniofacial anomaly with multiple surgical options in the armamentarium of a surgeon. Following the principles and right surgical techniques can yield excellent functional results. The various techniques have gradually developed over time and each has their own peculiarities along with specific advantages and disadvantages. Here, in this article, we will be discussing a few palatoplasty techniques which have stood the test of time and are commonly performed.

Early Cleft Palate Repair by a Modified Technique Without Relaxing Incisions.

This study sought to evaluate a modified palatoplasty technique (MPT) concerning the postoperative outcomes and associated influencing factors. A retrospective cohort study. One hundred forty-three consecutive patients with non-syndromic cleft palate, who received MPT before one year of age within an oral and maxillofacial surgery department of a university-affiliated tertiary hospital between 2011-2017, were reviewed. The postoperative wound healing and velopharyngeal function (VPF) were the primary outcome measures. The sex, age at surgery, cleft type, cleft width, palatal width, soft palate length, pharyngeal cavity depth, and operation duration were preselected as influencing factors. Univariate and multivariate analyses were conducted. The mean age at surgery was 9 ± 1.31 months (5-11), and the average cleft width was 9.03 ± 2.41 mm (4-15). The rate of incomplete cleft palate was 84.6% while the complete cleft palate was 15.4%. Complete wound healing was reported in 96.5% while the others (3.5%) had persistent oronasal fistula. About 90.2% of cases have shown normal velopharyngeal function whereas the others (9.8%) had sustained velopharyngeal insufficiency. The wound healing appeared to be significantly impacted by cleft width and pharyngeal cavity depth (P = .015 and 0.049, respectively). However, none of the factors had a significant association with VPF. The present modified palatoplasty technique has obtained a low fistula rate and appropriate speech outcome. Therefore, this MPT could be promoted for early repairing cleft palate of different severities.

The Sommerlad-Furlow Modified Palatoplasty Technique: Postoperative Complications and Implicating Factors.

To explore the incidence of postoperative complications and investigate the impact of preselected factors on functional and quality of life outcomes following the Sommerlad-Furlow modified palatoplasty technique. Retrospective cohort. A total of 429 patients with cleft palate, who received Sommerlad-Furlow modified technique between 2011-2017 were enrolled. The postoperative complications including oronasal fistula (ONF), velopharyngeal insufficiency (VPI), and inadequate quality of life (QOL) were collected. Data of preselected factors including gender, age at palatoplasty, cleft type, cleft width, palatal width, pharyngeal cavity depth, and operation duration were also collected. Among 429 patients, 40.1% were males whereas 59.9% were females. The mean age at palatoplasty was 1.23 ± 0.69 (0.42-4) years, and the average cleft width was 10.15 ± 2.95 (4-27) mm. The cleft types had recorded rates of about 6.8%, 69.5%, 17.7%, and 6.1% of Veau I, II, III, and IV, respectively. The overall incidence rates of ONF, VPI, and inadequate QOL were 2.3%, 19.4%, and 31.3%, respectively. In both the univariate and multivariate analyses, the cleft type was significantly implicated in ONF formation (p= 0.023 and 0.032, respectively) whereas the velopharyngeal function was impacted by the palatoplasty age (p˂0.001). The receiver operating characteristic curve indicated that age of palatoplasty ≥1.3 years (area under the curve=0.611, p= 0.002) was the cutoff value for predicting the incidence of VPI. The Sommerlad-Furlow modified technique appears to have appropriate postoperative outcomes, even in the wide cleft palate. The older age at palatoplasty has a major impact on the overall postoperative outcomes. 4 Laryngoscope, 133:822-829, 2023.

Wound healing complications following folded flap palatoplasty in brachycephalic dogs.

To determine the incidence and characteristics of wound healing complications after folded flap palatoplasty (FFP). Prospective study of 25 dogs that underwent FFP as a component of corrective multilevel surgery for brachycephalic obstructive airway syndrome. Oropharyngeal re-examination was conducted after a minimum of 28 days post-operatively, unless indicated earlier by the onset of clinical signs. Wound healing complications occurred in nine dogs (36%). Minor and major wound complications were diagnosed at a median of 36 days (1.5-51 days) post-operatively. Eight dogs had major wound complications, four of which showed no associated clinical signs. Two patterns of major wound complications were observed: incisional dehiscence (ID) with caudal retraction of the soft palate mucosa and development of a full-thickness defect (FTD) in the centre of the soft palate. Revision of the soft palate surgery was performed in five dogs, failing again in one dog with ID. Clinical signs resolved in symptomatic dogs after revision surgery to close FTD. In this study, wound healing complications were common after FFP and were not associated with significant clinical deterioration. Further research is necessary to determine the value and timing of routine post-operative oropharyngeal examination for assessment of soft palate healing after FFP as well as the indication for and success of approaches to the management of wound healing complications. The two distinct patterns of FFP failure recognised may provide insight into the underlying causes and lead to refinements in folded flap palatoplasty technique.

Teaching the Furlow Palatoplasty to Medical Students: A Randomized, Controlled Trial Evaluating a Low-Fidelity Model.

Teaching the Furlow Palatoplasty to Medical Students: A Randomized, Controlled Trial Evaluating a Low-Fidelity Model.

20. Teaching the Furlow Palatoplasty Technique: A Randomized, Control Trial Comparing Traditional Didactic Methods to a Low-fidelity Model

20. Teaching the Furlow Palatoplasty Technique: A Randomized, Control Trial Comparing Traditional Didactic Methods to a Low-fidelity Model

Three-Dimensional Assessment of Eustachian Tube in Patients With Cleft Palate Versus Controls: A CBCT Study.

To compare the morphological characteristics of the Eustachian tube (ET) between patients with cleft palate and healthy controls with the use of cone-beam computed tomography (CBCT). Retrospective assessment of treated nonsyndromic patients with cleft palate and a control group. CBCT images of 51 patients with cleft palate who had previously undergone surgery to close the cleft palate and a control group of 51 patients were included in this study. Syndromic patients were excluded. The cleft group were divided into 3 groups according to the palatoplasty technique, which was done in the infancy period to close the cleft palate (Nadjmi modification of Furlow, Sommerlad, and V-Y pushback). Finally, ET length (ETL), ET angle, and auditory tube angle (ATA) were measured in all patients. The ETL, ETA, and ATA in the cleft and the normal control groups were 29.73 ± 3.14 and 32.18 ± 3.34 mm, 33.18 ± 2.57 and 35.40 ± 3.93, and 141.64 ± 4.13 and 138.87 ± 4.96, respectively. All 3 features were statistically significant among the groups (All Ps &lt; .05). ETL and ETA were significantly higher in Nadjmi modification of Furlow and Sommerlad palatoplasty techniques compared to the V-Y pushback technique, while there was no significant difference in the ATA between the palatoplasty groups. Cleft palate can significantly affect the morphological characteristics of the ET. Type of the infancy palatoplasty can influence some of its dimensions.

The Use of Segmental Bone Resection to Assist in a Tension-Free Cleft Palate Repair

The traditional two-flap palatoplasty technique described by Veau-Wardill-Kilner is a two-flap palatoplasty suggests a posterior pushback movement of flaps should require an intact pedicle. Even a proper dissection of greater palatine vessels is done, some sort of tension burdens on the flaps due to the traction of the pedicle is inevitable. In addition to that, the right-angled flexion of the pedicle at the posteromedial bony corner of foramina palatinum majus diminishes blood flow. Particularly, in wide clefts, tight approximation of flap compromises the wound healing and resulting fistulas. A segmental bone resection from posteromedial wall of foramen palatinum majus as an outfracturing fashion is performed to assist a tension-free cleft palate repair. The more release of the pedicle from its hole loosens the flaps. It provides an easy posteromedial transposition of tissues. This maintains also most push-back movement of flaps.

Primary Palatoplasty: A Comparison of Results by Various Techniques - A Retrospective Study.

Introduction:To identify a better method for primary cleft palate (CP) repairs with respect to velopharyngeal function.Materials and Methods:A retrospective, longitudinal review of medical charts of patients with congenital CP who underwent four different techniques of palatoplasty, performed by three different surgeons in the Department of Maxillofacial Surgery of the National Center for Maternal and Child Health. Nasopharyngoscopy (NPS) was used for velopharyngeal function evaluation. CP was classified according to the Veau system and the “Golding-Kushner” scale for NPS results was used for assessing the patient’s velopharyngeal function and its association with cleft types and the primary palatoplasty techniques. Pearson’s Chi-square analysis and binary logistic regression were used for statistical analysis.Results:A total of 335 patients were included in the study. The mean age at primary palate repair was 22.9 ± 13.6 months. There were 56, 42, 177, and 60 patients with Veau-I, Veau-II, Veau-III, and Veau-IV types, respectively, whereas for primary palatoplasty 65 patients underwent Furlow, 148 patients – Mongolian, 108 patients – two flap, 34 patients – von Langenbeck technique. NPS assessment of adequate velopharyngeal function was followed by Furlow’s technique in 89.4% of cases, Mongolian technique in 62.2% of cases but by “two flap” only in 48.1% and von Langenbeck in 47.1% of cases.Discussion:The Furlow and Mongolian techniques were superior for maintaining velopharyngeal function after primary palatoplasty.

Effect of Cleft Palate Repair Using Alveolar Extension Palatoplasty Technique on Eruption of Primary Teeth

Effect of Cleft Palate Repair Using Alveolar Extension Palatoplasty Technique on Eruption of Primary Teeth

Comparative Evaluation of Palatal Length, Speech Outcome, and Surgical Complications With Use of Von Langenbeck and Bardach 2 Flap Technique for the Repair of Cleft Palate: A Prospective Randomized Study

Purpose: Successful closure of cleft palate is no more the sole criteria for determining the success of palatoplasty. Approximating soft palate musculature plays an equally important role. A continuous palate with muscular sling, speech and unhampered maxillary growth are 3 important goals of palatoplasty. The current study compared 2 popular palatoplasty techniques and also focused on other vital secondary parameters which would alter the final outcome of palatoplasty. Methods: Thirty-two primary cleft palate patients with repaired cleft lip ranging from 4 to 30 years were randomly and equally divided into 2 groups. Group A underwent Langenbeck and Group B underwent Bardach palatoplasty. Sommerlad’s Intra-Velar Veloplasty was performed in all patients. The patients were evaluated for certain palatal and cleft measurements, speech, and surgical complications. The study also compared impact of cleft severity on speech and complications. Results: All the patients showed improvement in palatal length and speech. Significant palatal lengthening was achieved by Bardach as compared to Langenbeck palatoplasty ( P = .002). Amongst the various speech parameters so compared Bardach group showed better speech articulation post-operatively ( P = .020). No significant difference was found between the 2 groups in relation to other speech parameters. Total 4 complications were encountered 2 belonging to each group. Conclusion: Hard palate cleft repair technique plays little role as far as speech outcomes are concerned. It was Intravelar Veloplasty which reestablished the velopharyngeal sphincter and improved the quality of speech. Hence restoring the muscular sling of soft palate using radical dissection should be stressed upon by the surgeons besides the closure of cleft. The current study found few confounding factors such as age, cleft width, and Veau’s class which altered the speech outcomes and/or complications of palatoplasty.

Furlow Versus Straight Line Repair With Intravelar Veloplasty: A 7-Year Single Institution Experience with Fistula Formation

Introduction: We aimed to characterize and identify potential risk factors for fistula formation including demographic variables, palatoplasty technique, Veau cleft classification, and adoption status at a large tertiary pediatric facility. Methods: Retrospective chart review was performed for patients undergoing primary palatoplasty via either Furlow or straight line with intravelar veloplasty (IVVP) technique from November 2011 to September 2018. Variables collected included age at time of surgery, gender, language, payer status, adoption status, syndromic status, presence of moderate and/or bilateral hearing loss, Veau cleft type, and presence of a postoperative fistula. Results: Of the 108 patients included, 34 underwent the Furlow procedure and 74 underwent the straight line repair procedure with IVVP. A significant correlation was found between fistula formation and both adoption status and Veau cleft type. Only patients with Veau cleft types 3 and 4 developed a postoperative fistula. Postoperative fistulae developed in 9 patients: 1/34 (2.9%) in the Furlow group and 8/74 (10.8%) in the straight line with IVVP group. Conclusions: At our institution, rate of fistula formation is not greatly different between Furlow and straight line with IVVP palatoplasty techniques despite their being a trend toward increased risk of postoperative fistulas within the latter group, supporting previous literature that did not find an association between technique and fistula rate. Veau cleft classification and adoption status were more closely associated with the formation of postoperative fistulae.

The Assessment of 3D Digital Models Using GOSLON Yardstick Index: Exploring Confounding Factors Responsible for Unfavourable Treatment Outcome in Multi-Population Children With UCLP.

To evaluate dental arch relationship (DAR) using GOSLON Yardstick and also to explore the association between multiple factors (age, gender, UCLP types, UCLP side, Family history of cleft, family history of Class III malocclusion, techniques of cheiloplasty, techniques of palatoplasty) and DAR in children unilateral cleft lip and palate (UCLP) in different populations. Two hundred fifty-five laser scanned 3D digital models (LS3DM) of UCLP children (5–12 years) from Malaysia, Bangladesh, and Pakistan were included. The intra- and inter-examiner agreements were evaluated by kappa statistics, to compare the GOSLON mean score between the populations and to explore the responsible factors that affect DAR, one way ANOVA, and crude logistic regression analysis was used, respectively. The mean GOSLON score was 2.97; 3.40 and 3.09 in Malaysia, Bangladesh, and Pakistan, respectively. Twenty seven, 40, and 30 subjects were in unfavourable (category rating 4 and 5) groups in Malaysia, Bangladesh, and Pakistan, respectively. A significant association was found between techniques of palatoplasty (p = 0.03; p = 0.04 and p = 0.04 in Malaysia, Bangladesh, and Pakistan, respectively) and unfavourable DAR. Different cheiloplasty techniques (p = 0.04) and gender (p = 0.03) also exhibited noteworthy associations with unfavourable DAR in the Bangladeshi population. Bardach techniques of palatoplasty were significantly associated with unfavourable DAR in all three populations. Moreover, male UCLP and modified Millard techniques of cheiloplasty were also associated with unfavourable DAR in the Bangladeshi population.

Correlation between surgical protocols for palatoplasty and midfacial growth in cleft lip and palate patients: A long-term, single centre study

To evaluate and compare the outcomes of two different surgical protocols for palatoplasty for midfacial growth in patients with cleft lip and palate.A retrospective observational cohort study was conducted in 80 patients with cleft lip and palate, who were divided into two groups. Group 1 comprised patients who underwent operation between 9 and 11 months of age using the Bardach two-flap technique without a palatal pushback. Group 2 comprised patients who had undergone operation between 18 and 20 months of age using either a Bardach two-flap technique with a palatal pushback or a von Langenbeck technique. Patient follow-up was done between 8 and 9 years of age when they reported to the centre for secondary alveolar bone grafting. Post-surgical cephalometric measurements were taken for midfacial growth analysis.Group 1 underwent palatoplasty at significantly younger ages than Group 2 (p < 0.01). A statistically significant difference(p < 0.01) was found between the two groups of patients on comparison of cephalometric parameters such as SNA, ANB, CoA, NperpA ANS-PNS, N-ANS, N–Me, Witt's (AO-BO). Group 2 had more positive cephalometric values as compared to Group 1, thereby implying that there was less incidence of midfacial hypoplasia in patients treated at the age of 18–20 months. Between the types of palatoplasty techniques within Group 2, i.e., Bardach two-flap and von Langenbeck, there was no statistical difference found in the post-opertative cephalometric values, i.e., SNA, ANB, CoA, ANS-PNS, N-ANS, N–Me, Witt's (AO-BO) except for Nperp-A, which showed a statistical difference (p = 0.03).Within the limitations of the study which is only a single center experience it seems that palatal closure should be carried out at 18–20 months of age for better midfacial growth, leading to decreased incidence of maxillary hypoplasia at a later stage in life. Repair at less than 18 months of age is also associated with mid-facial hypoplasia.

Does the Timing of 1-Stage Palatoplasty With Radical Muscle Dissection Effect Long-Term Midface Growth? A Single-Center Retrospective Analysis.

To evaluate the long-term effect of timing of 1-stage palatoplasty on midfacial growth in patients with cleft lip and palate (CLP). Retrospective observational cohort study. Institutional hospital. One hundred twelve patients with CLP who underwent palatoplasty and were divided into 3 groups: group I: operated between 9 and 11 months; group II: operated between 18 and 20 months; and group III: operated between 21 and 24 months. All patients underwent von Langenbeck palatoplasty technique, which was converted to a Bardach 2-flap technique in case of any technical difficulties. The patients were followed up between 8 and 9 years when they reported for secondary alveolar bone grafting. Postsurgical cephalometric and dental casts measurements were taken for midfacial growth analysis. The cephalometric measures were analyzed for midfacial growth and compared within the groups. Statistically significant difference (P < .01) was found on comparing the cephalometric parameters such as sella-nasion-A point angle (SNA), A point-nasion-B point angle (ANB), n toperpendicular to point A (N-perpA), condylon to point A (Co-A), anterior nasal spine to posterior nasal spine (ANS-PNS), nasion to Anterior nasal spine (N-ANS), nasion to menton (N Me), and witts appraisal (Witt (AO-BO)) in group I when compared to both group II and group III patients, implying deficient midfacial growth in group I. No statistical difference was found in the cephalometric values between group II and group III. Group II had better cephalometric measurements than group III, showing better growth in group II than group III. Overall, there was less incidence of midfacial hypoplasia in patients treated between 18 and 20 months (group II). We conclude that palatal closure carried out at 18 to 20 months and 21 to 24 months is associated with better midfacial growth when compared to closure at 9 to 11 months. The best time to operate would be between 18 and 20 months to avoid speech disturbances. Midfacial growth can be greatly influenced by the timing of 1-stage palatoplasty.

Application of Buccal Fat Pad as Adjunct Flap for Lateral Defect Closure in Palatoplasty

Summary: Cleft lip and palate are the most widely recognized craniofacial congenital malformation. The buccal fat pad (BFP) can be utilized to close lateral fistulas at the time of palatoplasty due to its rich blood supply and simple accessibility. The aim is to report on the use of BFP as a pedicled flap in cleft palate surgery and to discuss promising results for this reconstructive concept. The case subject was a five-year-old male born with cleft lip and palate; the cleft lip was operated on 4 months old. The patient was operated on using Bardach's two flap palatoplasty techniques, and for the closure of the lateral lining defect, the BFP was used as a pedicled flap. After the surgery, no abnormality was found, including infection, graft loss, palatal fistulas, or cheek depression. All wounds were fully epithelialized. In palatoplasty, BFP is a safe and reliable method with a fast healing benefit.