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

Abstract

Primary palatoplasty for cleft palate places patients at high risk for scarring, altered vascularity, and persistent tension. Palatal fistulas are a challenging complication of primary palatoplasty that typically form around the hard palate–soft palate junction. Repairing palatal fistulas, particularly wide fistulas, is extremely difficult because there are not many choices for closure. However, a few techniques are commonly used to close the remaining fistula after primary palatoplasty. Herein, we report the revision of a palatal fistula using a pedicled buccal fat pad and palatal lengthening with a buccinator myomucosal flap and sphincter pharyngoplasty to treat a patient with a wide palatal fistula. Tension-free closure of the palatal fistula was achieved, as well as velopharyngeal insufficiency (VPI) correction. This surgical method enhanced healing, minimized palatal contracture and shortening, and reduced the risk of infection. The palate healed with mucosalization at 2 weeks, and no complications were noted after 4 years of follow-up. Therefore, these flaps should be considered as an option for closure of large oronasal fistulas and VPI correction in young patients with wide palatal defects and VPI.

Myomucosal island flap in the reconstruction of oral cavity defects: Description of the surgical technique

“…Over the last two decades, the FAMMIF has found multiple useful applications in the reconstruction of defects in the head and neck area. These are not limited to cancer surgery but also to post‐traumatic defects and to the rehabilitation of cleft lip and palate patients 12,13 . Undoubtedly, due to its anatomical and tissue characteristics, this flap is ideal for the oropharynx, floor of mouth and tongue reconstruction.…”

“…These are not limited to cancer surgery but also to post‐traumatic defects and to the rehabilitation of cleft lip and palate patients. 12 , 13 Undoubtedly, due to its anatomical and tissue characteristics, this flap is ideal for the oropharynx, floor of mouth and tongue reconstruction. In particular, the FAMMIF is indicated in the reconstruction of small to moderate defects (post T1‐T2 tumors resection) when single functional units are involved.…”

Pedicled buccal flaps as a backup procedure for intraoral reconstruction

“…This variety in harvesting techniques and flap thickness offers a broad field of application in tension-free, watertight, and localised defect closure. Apart from its traditional indication for primary closure of wide palatal clefts or as a backup procedure for palatal lengthening in velopharyngeal dysfunction, many case reports on the topic have been published [ 15 , 16 ]. In 1989, Bozola et al reported a cadaver and clinical study on the axial patterned buccinator musculomucosal flap, which had been successfully applied not only in cleft surgery but also in tumour surgery and osteomyelitis [ 14 ].…”

Managing massive palatial defect secondary to palatoplasty failures: an in-depth analysis

“…It offers an ample amount of tissue for effective defect coverage, making it a reliable choice for medium-sized defects [26]. One of its distinguishing features is the potential for mucosa-to-mucosa replacement, facilitating optimal functional and aesthetic outcomes [27]. Moreover, BMF is associated with relatively low morbidity and yields optimal functional and cosmetic results [27,28 ▪ ].…”