Buccal Fat Pad Adjunctive Flap During Primary Cleft Palate Repair: Effects on Maxillary Dimensions and Molar Eruption

ObjectiveTo evaluate maxillary growth differences when buccal fat pad graft (BFP) is utilized during primary cleft palate repair, and to evaluate the need for later surgical revision of the BFP due to non-eruption of maxillary permanent molars.DesignRetrospective cohort study.SettingInstitutional hospital and clinic.PatientsPatients with CP ± L who underwent primary palatoplasty with or without BFP.InterventionsMaxillary measurements of pre-orthodontic dental models.Main outcome measureMaxillary dimensions, disruption to maxillary permanent molar eruption.ResultsPatients treated with BFP exhibited a tendency toward an increased maxillary posterior width and a more favorable maxillomandibular posterior transverse relationship (P = 0.069 and 0.072, respectively). A similar percentage of patients required maxillary expansion between the non-BFP and BFP-treated group (P = 0.103). Secondary surgical revision was recommended for 70.6% of BFPs placed due to inhibition of eruption of the maxillary permanent molars. 33.3% of BFP revisions were not combined with any other surgical procedure during the general anesthesia event.ConclusionThe use of BFP adjunctive flap during primary palatoplasty likely allows for increased transverse growth of the posterior maxilla during childhood and likely reduces the maxillomandibular posterior arch width discrepancy. However, the use of this graft does not reduce the proportion of patients who require orthodontic maxillary expansion. Patients may experience disruption of maxillary permanent molar eruption, and 70.6% of BFPs placed require secondary surgical intervention under general anesthesia to reposition the flap in late childhood.