Buccinator Myomucosal Neurovascular Island Flap: Anatomical Cadaveric Study and Clinical Experience

Use of peninsular buccal flaps for primary cleft palate repair is well documented in the literature. However, there is no report on the application of an island flap for primary cleft palate repair. This study aims to reveal the clinical application of an axial neurovascular propeller buccinator myomucosal flap.

An anatomical study was performed by injection into the buccal pedicle of 22 fresh hemifacial cadavers. In addition, we analyzed palatal healing and flap outcomes in 25 primary cleft palate reconstructions using 36 pedicled propeller flaps.

In the cadaver study, the mean buccal artery diameter was 1 ± 0.3 mm, the neurovascular pedicle entered the flap 11.4 ± 2.9 mm anterior to the pterygomandibular raphe (one-sixth the length of the flap), and the buccal artery advanced inside the flap as much as 66.8% ± 6.0% of the total flap length. Based on clinical experience, all reconstructions were performed using a modified Furlow palatoplasty. Mean age of patients was 15.3 months and mean maximum cleft width was 11.7 mm. Eleven cases used bilateral flaps. The flap always reached the contralateral pillar, and the buccal nerve was always preserved; 11.11% of flaps (4 of 36) underwent scar revision, and 5.56% of flaps (2 of 36) were lost. The follow-up period was 11.3 months.

This study suggests that the use of axial neurovascular pedicled propeller buccinator myomucosal flaps is a safe and reliable option in primary cleft palate reconstruction. Our anatomical dissections and clinical outcomes reveal the consistent and robust nature of the buccal neurovascular pedicle, and our modified surgical technique allows for preservation of the buccal nerve.