A Preliminary Study of Anatomical Changes Following the Use of a Pedicled Buccal Fat Pad Flap During Primary Palatoplasty

Abstract

Objective: The purpose of this study was to examine the surgical impact of the pedicled BFP flap on the LVP muscle and surrounding VP anatomy following primary palatoplasty.

Design: Observational, prospective

Setting: MRI studies were completed at 3 imaging facilities. All participants with BFP flap were operated on by the same surgeon.

Participants: Five pediatric participants with CP±L who underwent primary palatoplasty with BFP flap placement. Comparison groups consisted of 10 participants: 5 with CP±L who did not receive the BFP flap and 5 healthy controls.

Interventions: All participants underwent nonsedated MRI 2–5 years postoperatively.

Main Outcomes and Measures: Anatomical measures of the velopharynx and LVP among the 3 participant groups

Results: Median values were significantly different among groups for velar length (p = .042), effective velar length (p = .048), effective VP ratio (p = .046), LVP length (p = .021), extravelar LVP length (p = .009), and LVP origin-origin distance (p = .030). Post hoc analysis revealed a statistically significant difference between the BFP and traditional repair groups for effective VP ratio (p = .040), extravelar LVP length (p = .033), and LVP length (p = .022).

Conclusions: This study provides preliminary support that the BFP flap creates a longer velum, with increased distance between the posterior hard palate and the LVP, and a larger effective VP ratio compared to traditional surgical techniques. Future research is needed to determine if this procedure provides a more favorable mechanism for VP closure.