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Buccal Fat Pad in Primary and Secondary Cleft Palate Repair: A Systematic Review of the Literature
Carolina Romero-Narvaez1, Lawrence O Lin2, Richard E Kirschner1,3
1Plastic and Reconstructive Surgery Service, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.
Insights
The buccal fat pad (BFP) shows promise in cleft palate repair, potentially reducing fistulas and improving maxillary growth. However, current evidence quality is low, requiring further high-quality research.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Cleft palate repair remains a challenge with potential complications like fistulas and maxillary hypoplasia.
- The buccal fat pad (BFP) is increasingly explored as a reconstructive option in these procedures.
Purpose of the Study:
- To systematically review evidence on buccal fat pad (BFP) use in primary and secondary cleft palate repair.
- To evaluate the short- and long-term clinical outcomes associated with BFP in cleft palate surgery.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched PubMed/Medline, Embase, and Web of Science for studies on BFP and cleft palate repair.
- Included 23 studies (13 case series, 10 comparative) with low overall evidence and high risk of bias.
Main Results:
- In primary repair, BFP was used for lateral relaxing incisions and mucosal defects, with a 2.8% fistula incidence.
- Studies indicated wider transverse maxillary dimensions post-BFP use.
- No increased complications like bleeding, infection, or flap necrosis were reported.
- In secondary repair, BFP use for fistula repair showed no recurrent fistulas.
Conclusions:
- Buccal fat pad (BFP) demonstrates potential benefits in preventing and managing fistulas and enhancing transverse maxillary growth.
- Significant heterogeneity, high risk of bias, and low evidence quality necessitate cautious interpretation.
- High-quality research with extended follow-up is essential to confirm these findings.
Abstract:
ObjectiveTo review the evidence supporting the use of buccal fat pad (BFP) in primary and secondary cleft palate repair and its short- and long- term clinical outcomes.DesignSystematic review conducted by 2 independent reviewers following PRISMA guidelines.Setting: None ParticipantsArticles were identified from three databases (Pubmed/Medline, Embase and Web of Science). Search terms included "cleft palate", "palatoplasty", "palate repair", "buccal fat pad".InterventionsUse of BFP in primary and secondary cleft palatoplasty.Main Outcome MeasuresPrimary outcomes were immediate postoperative complications, postoperative fistula, and maxillary growth. Secondary outcomes were palatal length, speech, and donor site morbidity.ResultsNinety-one reports were retrieved after excluding duplicates. Twenty-three studies were included (13 case series and 10 comparative studies). Overall level of evidence was low. Randomized and non-randomized studies had a high risk of bias. In primary palatoplasty, BFP was more frequently used filling lateral relaxing incisions(57.4%), or in the hard-soft palate junction and covering mucosal defects(30.1%). In these patients, post operative fistula incidence was 2.8%. Two studies found wider transverse maxillary dimensions after BFP use. No higher incidence of bleeding, infection, dehiscence, or flap necrosis was reported. In secondary palatoplasty, no recurrent fistulas were reported for patients undergoing BFP for fistula repair.ConclusionsBFP appears to be associated with a favorable impact in fistula prevention and management, as well as in transverse maxillary growth. However, there is a high heterogeneity among studies, high risk of bias and overall low quality of evidence. More high-quality research with long-term follow-up is warranted.
