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

While use of buccal fat pad flaps (BFPF) in primary palatoplasty has been shown to improve speech and reduce velopharyngeal insufficiency risk, the risk for obstructive sleep apnea (OSA) remains unknown. We hypothesize that using BFPFs in primary palatoplasty does not confer additional risk for OSA due to its favorable influence on palatal development and velopharyngeal mechanics.

A retrospective review identified patients who underwent cleft palatoplasty with or without BFPFs from 1995-2016. The primary outcome measure was the rate of OSA diagnosed by pulmonary sleep medicine with prescription for continuous positive airway pressure (CPAP) therapy. Secondary outcomes included need for adenotonsillectomy (T/A), resolution of obstructive sleep symptoms with T/A, and development of OSA after speech surgery.

During primary palatoplasty, 100 patients received BFPF(s), while 110 patients did not. Incidence of OSA with BFPFs was 9.0% (n=9) compared to 8.2% (n=9) without BFPFs (p=0.832), with an adjusted risk difference of 1.3% (±6.6%). Neither the quantity nor location of BFPFs was associated with increased risk for OSA. There was no significant difference in the rate of T/A or the rate of symptom resolution following T/A. One patient with BFPFs and four patients without BFPFs developed OSA after speech surgery. Two patients without BFPFs developed OSA after revision for palatal fistula.

This study demonstrates no statistically meaningful increase in risk for development of OSA when BFPFs are incorporated into primary cleft repair. Given the favorable impact BFPFs have on speech we continue to recommend their use in primary palatoplasty.