Versatility of buccal myomucosal flap for secondary cleft palatal defects- our experience with 123 cases

Cleft palate repair aims to restore both the anatomical and functional integrity of the palate. Despite advancements in surgical procedures, palatal fistulas continue to be a severe problem, affecting speech, swallowing, and quality of life. The. This study investigates the efficacy of buccal myomucosal flaps in closure of secondary cleft palatal defects, with an emphasis on larger anterior fistulas.

We treated 123 patients with palatal fistulae using buccal myomucosal flaps from 2008 to 2023. All cases involved a two-layer closure technique using a posteriorly based buccal artery pedicle. Patients were followed up postoperatively at intervals of 1 week, 1 month, 3 months, 6 months, and 12 months. Speech outcomes were assessed preoperatively and postoperatively.

The study included 62 females and 61 males with mean age 6 years 11 months. The original defects included unilateral, bilateral, and isolated cleft palates. Most fistulas (43%) were located at the anterior hard palate. Buccal flaps were taken from the right side in 64% of cases, left side in 23%, and bilaterally in 12%. The largest fistula measured 6 cm × 7 cm, and the smallest 11 mm × 18 mm. Postoperative complications were minimal, with no cases of hemorrhage, infection, or flap necrosis. Speech analysis showed significant improvement across all measures.

The buccal myomucosal flap is a versatile and effective technique for secondary cleft palatal defect repair. It provides a reliable solution for closing fistulas and lengthening the soft palate, with minimal complications and significant improvements in speech.