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BUCCAL FAT PAD FLAP AS A LOW-TRAUMA METHOD FOR
IMPROVING OUTCOMES IN WIDE CLEFT PALATE SURGERY IN
INFANTS
Rejamatov T.R.
National Children's Medical Center of Tashkent
https://doi.org/10.5281/zenodo.15261243
Abstract
This study evaluates the effectiveness of using a buccal fat pad flap in the
surgical correction of wide cleft palates in children. The technique aims to
reduce postoperative complications such as oronasal fistulas, scar contractures,
velopharyngeal insufficiency, and midface hypoplasia. Surgical outcomes were
analyzed in patients aged 9 months to 2 years, with a focus on the optimal age of
1.5 years. The results demonstrate high effectiveness of the method due to the
flap’s rich vascularity, pliability, and low trauma. The use of the buccal fat pad
flap significantly improves both anatomical and functional outcomes of cleft
palate repair.
Keywords
cleft palate, buccal fat pad, fistula, velopharyngeal insufficiency, palate
repair, facial surgery, midface hypoplasia, postoperative complications
Relevance
Cleft palate repair in children remains one of the most challenging tasks in
reconstructive surgery. Major postoperative complications include the
formation of oronasal fistulas and excessive scarring, which may lead to facial
deformities and impaired function. Wide clefts present an even greater
challenge, as conventional closure techniques often result in excessive tissue
tension and subsequent dehiscence. The buccal fat pad flap has emerged as a
promising method due to its soft texture, excellent vascularity, and ability to fill
defects without creating tension. This study is highly relevant in the context of
improving surgical outcomes in children with congenital anomalies. It addresses
the need for reliable, low-risk techniques that minimize the need for
reoperations and optimize long-term functional and aesthetic results. The
method has the potential to become a standard in treating complex cleft palate
cases, particularly in young children at the optimal age for repair.
Research Aim
To justify the use of the buccal fat pad flap in correcting wide cleft palates in
children to prevent fistula formation, scar contracture, velopharyngeal
insufficiency, and midface hypoplasia.
Materials and Methods
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The study included 40 children with cleft palates who underwent surgery
between the ages of 9 months and 2 years. Patients were divided into two
groups: a control group (standard technique) and a study group (buccal fat pad
flap used). A retrospective analysis was conducted to assess the incidence of
complications, wound healing, fistula formation, and functional outcomes.
Clinical, instrumental, and morphological assessment methods were used.
Statistical analysis was performed using SPSS software, employing the Student’s
t-test and chi-square (χ²) test to determine the significance of differences
between groups.
Results
The use of the buccal fat pad flap led to a significant reduction in
postoperative oronasal fistulas, observed in 15% of cases in the flap group
compared to 37.5% in the control group (p < 0.05), representing a 60% relative
decrease. Scar formation was classified as minimal or moderate in 90% of
patients in the flap group, versus 65% in the control group. Improved healing of
lateral palatal areas was observed in 85% of cases with the flap, compared to
60% in those without. Wound dehiscence occurred in 7.5% of the flap group
versus 20% in the control group. No statistically significant difference in
postoperative infection (5% vs 7.5%) or bleeding (2.5% vs 5%) was found
between groups. These findings confirm the buccal fat pad flap as a reliable and
safe adjunct in cleft palate repair.
Conclusion
The buccal fat pad flap demonstrated high efficacy in the surgical repair of
wide cleft palates in children. Its rich vascularization, low donor site morbidity
(complication rate <5%), and excellent tissue adaptability make it especially
effective in covering exposed bone and reinforcing high-tension closure areas.
The technique reduced oronasal fistula formation by 60%, improved lateral
wound healing by 25%, and lowered the rate of wound dehiscence by 12.5%.
Functional and aesthetic outcomes were rated as good to excellent in 92.5% of
the flap group versus 70% in the control group. Given these strong clinical
outcomes, the buccal fat pad flap should be considered a standard adjunct
technique, particularly in children around 1.5 years of age, when anatomical and
physiological conditions are most favorable for optimal healing.
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