Split Buccal Fat Flap in Modified Furlow Palatoplasty: Surgical Technique and Early Result

Abstract

Encouraging results have been described for the use of pedicled buccal fat pad flap in primary cleft palate repair. This retrospective study describes the surgical technique and early results of a technical innovation utilizing the split buccal fat flaps in modified Furlow palatoplasty with small double-opposing Z-plasty. This technique introduces buccal fat tissue for coverage of lateral denuded palate surfaces to reduce the bone exposure and scar formation to potentially attenuate maxillary growth interference and for reinforcement of the palatal areas of high tension or with incomplete closure to decrease the risk of postoperative dehiscence and oronasal fistula formation. Consecutive nonsyndromic patients (n = 56) with cleft palate were treated with this method, all of whom demonstrated fast mucosalization of lateral palatal recipient regions within 3 weeks postoperatively and showed no fistula with 12 months' follow-up. Of 19 patients (33.9 percent) who underwent auditory-perceptual assessment, 15 (78.9 percent) had normal resonance. Surgeons could add this alternative surgical maneuver to their armamentarium during the primary palatoplasty, in which coverage of lateral surfaces and reinforcement with fat tissue in the anterior soft palate space are of paramount relevance.

Reinforcing the Modified Double-Opposing Z-Plasty Approach Using the Pedicled Buccal Fat Flap as an Interpositional Layer for Cleft Palate Repair

“…Our retrospective analysis of the 6-month complication rate revealed that this modified Furlow double-opposing Z-plasty palatoplasty with the 3-layer repair of the hard and soft palates resulted in adequate cleft palate closure with rapid mucosalization of lateral relaxing incisions and no wound separation or fistula formation. This corroborates published data of satisfactory palatal healing status with reduced fistula rates following the use of pedicled buccal fat flaps in Furlow palatoplasties (Levi et al, 2009; Bennett et al, 2017; Qiu et al, 2019; Horswell and Chou, 2020; Kim et al, 2020; Thurston et al, 2020; Denadai and Lo, 2021). Interestingly, recent comparative investigations have demonstrated that adding buccal fat flaps in Furlow double-opposing Z-plasty palatoplasty improves the postoperative palatal length (Kotlarek et al, 2021a) and transverse maxillary development (Lo et al, 2021).…”

“…A growing body of literature has demonstrated the value of fat tissue in enhancing the healing process, with pedicled buccal fat flaps applied to improve the outcomes of Furlow doubleopposing Z-plasty palatoplasties (Levi et al, 2009;Yamaguchi et al, 2016;Bennett et al, 2017;Qiu et al, 2019;Jung and Lo, 2020;Thurston et al, 2020;Denadai and Lo, 2021;Lo et al, 2021;Kotlarek et al, 2021aKotlarek et al, , 2021b. Harvesting and placing of buccal fat flaps have increased operations by 10 to 15 min, without comprising the facial symmetry (Levi et al, 2009;Bennett et al, 2017;Qiu et al, 2019;Thurston et al, 2020;Denadai and Lo, 2021).…”

“…In this setting, results have encouraged the use of pedicled buccal fat pad flaps in original and modified Furlow double-opposing Z-plasty palatoplasties (Levi et al, 2009; Yamaguchi et al, 2016; Bennett et al, 2017; Qiu et al, 2019; Jung and Lo, 2020; Thurston et al, 2020; Denadai and Lo, 2021; Lo et al, 2021; Kotlarek et al, 2021a, 2021b). Interpositional buccal fat flaps have been applied in the anterior region of the soft palate to fill the dead space between the oral and nasal flaps, alleviating possible palatal contraction during the healing process, and reducing dehiscence or fistula formation (Qiu et al, 2019; Thurston et al, 2020; Denadai and Lo, 2021; Kotlarek et al, 2021a). The lateral denuded bone surfaces were covered with pedicled buccal fat flaps to reduce healing by secondary intention and subsequent impairment of the maxillary arch development, and maxillary growth (Levi et al, 2009; Yamaguchi et al, 2016; Jung and Lo, 2020; Denadai and Lo, 2021; Khan et al, 2021; Lo et al, 2021).…”

“…Interpositional buccal fat flaps have been applied in the anterior region of the soft palate to fill the dead space between the oral and nasal flaps, alleviating possible palatal contraction during the healing process, and reducing dehiscence or fistula formation (Qiu et al, 2019; Thurston et al, 2020; Denadai and Lo, 2021; Kotlarek et al, 2021a). The lateral denuded bone surfaces were covered with pedicled buccal fat flaps to reduce healing by secondary intention and subsequent impairment of the maxillary arch development, and maxillary growth (Levi et al, 2009; Yamaguchi et al, 2016; Jung and Lo, 2020; Denadai and Lo, 2021; Khan et al, 2021; Lo et al, 2021). We combined these potential benefits in a single intervention.…”

“…In this setting, results have encouraged the use of pedicled buccal fat pad flaps in original and modified Furlow doubleopposing Z-plasty palatoplasties (Levi et al, 2009;Yamaguchi et al, 2016;Bennett et al, 2017;Qiu et al, 2019;Jung and Lo, 2020;Thurston et al, 2020;Denadai and Lo, 2021;Lo et al, 2021;Kotlarek et al, 2021aKotlarek et al, , 2021b. Interpositional buccal fat flaps have been applied in the anterior region of the soft palate to fill the dead space between the oral and nasal flaps, alleviating possible palatal contraction during the healing process, and reducing dehiscence or fistula formation (Qiu et al, 2019;Thurston et al, 2020;Denadai and Lo, 2021;Kotlarek et al, 2021a). The lateral denuded bone surfaces were covered with pedicled buccal fat flaps to reduce healing by secondary intention and subsequent impairment of the maxillary arch development, and maxillary growth (Levi et al, 2009;Yamaguchi et al, 2016;Jung and Lo, 2020;Denadai and Lo, 2021;Khan et al, 2021;Lo et al, 2021).…”