Tissue adjuncts in primary cleft palate reconstruction: A systematic review.

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Surgery

Background:

• This review compares outcomes of various non-palatal tissue adjuncts used in primary palatoplasty to manage tension and provide coverage at the defect site.
• The study focuses on improving surgical outcomes for patients with cleft palate, a congenital condition affecting palate formation.

Approach:

• A comprehensive literature search was conducted across MEDLINE, EMBASE, and Cochrane Library using keywords related to cleft palate and surgical techniques.
• Data from 1332 patients (aged 3 months-5 years) were analyzed, including cleft severity, surgical techniques, outcomes, and follow-up periods.
• Statistical analyses, including logistic regression and chi-squared tests, were employed to investigate associations between variables.

Key Points:

• Buccal myomucosal flap (BMMF) was used in 45.4% of cases, buccal fat pad flap/graft (BFP) in 40.8%, and acellular dermal matrix (ADM) in 14%.
• Severe clefts (Veau III/IV) were more frequently repaired with BMMF compared to ADM and BFP.
• Oronasal fistula rates were 3.1% and velopharyngeal insufficiency (VPI) rates were 4%, both associated with Veau IV clefts. ADM use in severe clefts was linked to fistula formation.

Conclusions:

• Adjunct tissue use in primary palatoplasty can mitigate unfavorable outcomes in severe cleft palate cases.
• Buccal myomucosal flaps (BMMF) demonstrate superior performance due to inherent tissue properties.
• Buccal fat pad flaps (BFP) are effective in reducing oronasal fistula formation.