The Application of Buccal Fat Pad to Cover Lateral Palatal Defect Causes Early Mucolization

Khan, Iqra Muhammad; Cho, Namiya; Ahmed, Mehtab; Ahmed, Owais; Beg, Mirza Shehab Afzal

doi:10.7759/cureus.17532

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…Future investigation should also characterize the effect of controlling the size of Z-plasty (caliper-guided raising of small DOZ) as well as the absence of lateral relaxing incision on intraoperative palatal lengthening. A growing body of literature 9–12,20,22–24,67,68 has shown the adoption of the buccal fat flap in primary palatoplasty to mitigate bone denudation-related scar contracture and subsequent midfacial growth disturbance, but further research is needed to measure the impact of adding buccal fat flap on long-term outcome of small DOZ palatoplasty using medial incision approach. Prospective investigations could consider auxiliary cohort compositions, incorporating other surgical approaches 28,29,69,70 with and without the use of lateral relaxing incisions and other maneuvers to release tension.…”

Section: Discussionmentioning

confidence: 99%

Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible?

Denadai¹,

Seo

Pascasio³

et al. 2022

The Cleft Palate Craniofacial Journal

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Objective An inspiring early result with no oronasal fistula formation was recently described for a modified medial incision small double-opposing Z-plasty (MIsDOZ) for treating Veau type I cleft palate. This study describes an early single-surgeon experience in applying this newly proposed surgical approach. Design Retrospective single-surgeon study. Patients Consecutive nonsyndromic patients (n = 27) with Veau I cleft palate. Interventions Topographic anatomical-guided MIsDOZ palatoplasty with pyramidal space dissection (releasing of the ligamentous fibers in the greater palatine neurovascular bundle and pyramidal process region, in-fracture of the pterygoid hamulus, and widening of space of Ernst) performed by a novice surgeon (RD). Mean Outcome Measures Age at surgery, the presence of cleft lip, palatal cleft width, use of lateral relaxing incision, and 6-month complication rate (bleeding, dehiscence, fistula, and flap necrosis). A published senior surgeon-based outcome dataset (n = 24) was retrieved for comparison purposes. Results Twenty-two (81.5%) and 5 (18.5%) patients received the medial incision only technique and lateral incision technique, respectively ( P = .002). Age, presence of cleft lip, and cleft width were not associated (all P > .05) with the use of lateral incision. Comparative analysis between the novice surgeon- and senior surgeon-based datasets revealed no significant differences for sex (females: 74.1% vs 62.5%; P = .546), age (10.2 ± 1.7 vs 9.6 ± 1.2 months; P = .143), rate of lateral incision (18.5% vs 4.2%; P = .195), and postoperative complication rate (0% vs 0%). Conclusion This modified DOZ palatoplasty proved to be a reproducible procedure for Veau I cleft palate closure, with reduced need for lateral incision and with no early complication.

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Section: Discussionmentioning

confidence: 99%

Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible?

Denadai¹,

Seo

Pascasio³

et al. 2022

The Cleft Palate Craniofacial Journal

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“…99 New techniques for coverage of these defects includes using the buccal fat pad to supply a layer of highly vascularized tissue over the denuded bone, thus expediting mucosalization and minimizing scarring. 99,100 This technique involves harvesting a small portion of the buccal fat and fascia as a pedicled graft and then securing it to the gingival mucosa next to the bony defect. 99,100…”

Section: Hard Palate Repairmentioning

confidence: 99%

“…99,100 This technique involves harvesting a small portion of the buccal fat and fascia as a pedicled graft and then securing it to the gingival mucosa next to the bony defect. 99,100…”

Section: Hard Palate Repairmentioning

confidence: 99%

Updates in Cleft Care

Parham,

Simpson,

Moreno

et al. 2023

Semin Plast Surg

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Cleft lip and/or palate is a congenital malformation with a wide range of presentations, and its effective treatment necessitates sustained, comprehensive care across an affected child's life. Early diagnosis, ideally through prenatal imaging or immediately postbirth, is paramount. Access to longitudinal care and long-term follow-up with a multidisciplinary approach, led by the recommendations of the American Cleft Palate Association, is the best way to ensure optimal outcomes. Multiple specialties including plastic surgery, otolaryngology, speech therapy, orthodontists, psychologists, and audiologists all may be indicated in the care of the child. Primary repair of the lip, nose, and palate are generally conducted during infancy. Postoperative care demands meticulous oversight to detect potential complications. If necessary, revisional surgeries should be performed before the child begin primary school. As the child matures, secondary procedures like alveolar bone grafting and orthognathic surgery may be requisite. The landscape of cleft care has undergone significant transformation since early surgical correction, with treatment plans now tailored to the specific type and severity of the cleft. The purpose of this text is to outline the current standards of care in children born with cleft lip and/or palate and to highlight ongoing advancements in the field.

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“…Interpositional buccal fat flaps have been applied in the anterior region of the soft palate to fill the dead space between the oral and nasal flaps, alleviating possible palatal contraction during the healing process, and reducing dehiscence or fistula formation (Qiu et al, 2019; Thurston et al, 2020; Denadai and Lo, 2021; Kotlarek et al, 2021a). The lateral denuded bone surfaces were covered with pedicled buccal fat flaps to reduce healing by secondary intention and subsequent impairment of the maxillary arch development, and maxillary growth (Levi et al, 2009; Yamaguchi et al, 2016; Jung and Lo, 2020; Denadai and Lo, 2021; Khan et al, 2021; Lo et al, 2021). We combined these potential benefits in a single intervention.…”

Section: Introductionmentioning

confidence: 99%

Reinforcing the Modified Double-Opposing Z-Plasty Approach Using the Pedicled Buccal Fat Flap as an Interpositional Layer for Cleft Palate Repair

Denadai¹,

Chou

2021

The Cleft Palate Craniofacial Journal

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Pedicled buccal fat flaps have been adopted in primary Furlow double-opposing Z-plasty palatoplasty to reduce oronasal fistula formation or to attenuate maxillary growth disturbance. We combined both goals in a single intervention. This study describes a series of 33 modified Furlow small double-opposing Z-plasty palatoplasties reinforced with a middle layer of pedicled buccal fat flaps between the oral and nasal layers for full coverage of the dissected palatal surfaces, with rapid mucosalization of lateral relaxing incisions and no dehiscence or fistula formation.

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The Application of Buccal Fat Pad to Cover Lateral Palatal Defect Causes Early Mucolization

Abstract: ConclusionBFP is a good source of vascularized tissue to cover the hard palate bones after primary cleft repair. It is easy to harvest as a local tissue with a low learning curve. The epithelialization rate is faster than conventional methods with minimal complication rates.

Cited by 5 publications

References 19 publications

Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible?

Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible?

Updates in Cleft Care

Reinforcing the Modified Double-Opposing Z-Plasty Approach Using the Pedicled Buccal Fat Flap as an Interpositional Layer for Cleft Palate Repair

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