"Buccal Fat Pad Flaps in Primary Cleft Palatoplasty Improve Hypernasality Without Increasing Risk for Sleep Apnea".

Area of Science:

• Craniofacial surgery
• Pediatric surgery
• Sleep medicine

Background:

• Primary palatoplasty aims to improve speech and reduce velopharyngeal insufficiency.
• The impact of buccal fat pad flaps (BFPFs) on obstructive sleep apnea (OSA) risk is not well understood.
• BFPFs may positively influence palatal development and velopharyngeal function.

Purpose of the Study:

• To investigate whether the use of BFPFs in primary palatoplasty increases the risk of developing OSA.
• To evaluate the association between BFPFs and OSA incidence, need for adenotonsillectomy, and OSA development after speech surgery.

Main Methods:

• Retrospective review of patients undergoing cleft palatoplasty with or without BFPFs (1995-2016).
• Primary outcome: OSA diagnosis requiring continuous positive airway pressure (CPAP) therapy.
• Secondary outcomes: Adenotonsillectomy rates, symptom resolution post-T/A, and late-onset OSA.

Main Results:

• OSA incidence was similar between groups: 9.0% with BFPFs (n=9) vs. 8.2% without BFPFs (n=9) (p=0.832).
• No association found between BFPF quantity/location and OSA risk.
• No significant differences in adenotonsillectomy rates or outcomes; late-onset OSA was rare in both groups.

Conclusions:

• Incorporating BFPFs into primary cleft repair does not statistically increase OSA risk.
• BFPFs positively impact speech outcomes in primary palatoplasty.
• Continued recommendation for BFPF use in primary cleft repair is supported.