Background: The pedicled buccal fat flap has recently been applied to cover the lateral raw surfaces during palatoplasty as an attempt to mitigate scar-induced transverse maxillary constriction during growth, but with no formal long-term comparative analysis. This three-dimensional imaging-assisted study assessed its impact on posterior transverse maxillary development.
Methods: Cone beam computed tomographic scans from patients with unilateral cleft lip, alveolus, and palate who received buccal fat flap (buccal fat group; n = 22) or Surgicel (Surgicel group; n = 32) for covering lateral raw surfaces during modified Furlow palatoplasty at 9 to 10 months of age and had reached the age of 9 years were retrieved for analysis. Patients with unilateral cleft lip and alveolus (nonpalatoplasty group; n = 24) were also included for comparison. Using three-dimensional maxillary image models, linear (U6T-MSP and U6J-MSP) and area measurements were calculated for cleft and noncleft posterior maxillary sides and for total posterior transverse maxillary dimension.
Results: The buccal fat group had significantly (all p < 0.05) wider dimensions compared with the Surgicel group for all transverse maxillary measurements on both the cleft and noncleft sides, except for U6J-MSP and posterior palatal area parameters on the cleft side ( p > 0.05). The buccal fat group had significantly (all p < 0.05) wider total transverse maxillary dimensions compared with the Surgicel and nonpalatoplasty groups.
Conclusion: Covering the lateral raw surfaces with buccal fat flaps resulted in less posterior transverse maxillary constriction compared with the Surgicel-based covering procedure.
Clinical question/level of evidence: Therapeutic, III.
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