The Use of Acellular Dermal Matrix in Combination With Pedicled Buccal Fat Pad in Wide Cleft Palate Repair: A Case Report and Literature Review

Abstract

We describe a case of the combined use of acellular dermal matrix and pedicled buccal fat pad (BFP) in a wide U-shaped cleft palate repair. Acellular dermal matrix was used as a “patch” repair for the nasal mucosa defect as opposed to the conventional inlay graft. The advantages include reduced cost and a smaller avascular graft load. Lateral relaxing incisions were made to ensure tension-free closure of oromucosa at midline. Lateral oromucosa defect closure with well-vascularized pedicled BFP ensures enhanced healing, less palatal contracture and shortening, and reduced infection. The palate healed with mucosalization at 2 weeks, and no complications were noted at 6 months follow-up.

Effect of Acellular Dermal Matrix on Long-Term Speech Outcomes in Primary Palatoplasty with Radical Intravelar Veloplasty

“…Regarding the size and inset of ADM, Losee and other authors preferred an extensive coverage extending from the soft-hard palate junction to the alveolar gingiva, up to 4 cm in length, 5 while others favored the minimal use of graft material in the shape of a patch graft, to reduce the economic burden and risk of infection and necrosis by minimizing the load of the avascular graft. [17][18][19] The fixation method of the ADM should also be considered. In published literature, ADM was either fixated on the nasal lining alone, stabilized with fibrin glue, or left without any suture.…”

“…In published literature, ADM was either fixated on the nasal lining alone, stabilized with fibrin glue, or left without any suture. 2,12,17,[19][20][21] In our study, the ADM was fixated at two points; one was in the nasal lining at the soft-hard palate junction and the other was in the anterior margin of the levator complex. The primary purpose of the suture in the nasal lining was to decrease the dead space and act as a spacer to prevent the anterior migration of the levator complex.…”

Use of a buccinator myomucosal flap and bilateral pedicled buccal fat pad transfer in wide palatal fistula repair: a case report

“…The rate of postoperative fistula formation differs according to the surgical method, but generally ranges from 2.4% to 35%. Closure of large ONFs in patients with cleft palate is particularly complex for reconstructive surgeons [ 8 , 9 ]. Additionally, children with a wide cleft fistula commonly have reduced VPI, impaired language development, and an impacted quality of life [ 10 ].…”

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

“…In the literature, an interpositional layer has been created between the oral and nasal layers in the soft palate region using different alternatives (acellular dermal matrix, hemostatic gelatin sponge, collagen membrane, and platelet-rich plasma) to enhance mucosal healing and reduce fistula formation (Losee et al, 2008; Hudson and Pickett, 2015; El-Anwar et al, 2016; Li et al, 2017; Goh and Chia, 2019; Simpson et al, 2019; Ha et al, 2020; Tanaka et al, 2021). Modifications on palatal dissection (subperiosteal flap technique vs mucoperiosteal flap technique) (Leenstra et al, 1996; Ito et al, 2006) and lateral relaxing incision (only a small incision lateral to the hamulus or no use of lateral incision) (Karsten et al, 2003; Becker and Hansson, 2013; Parikakis et al, 2018; Seo et al, 2019) have also been proposed to attenuate bone denudation-related scar contracture and subsequent maxillary growth interference.…”