Buccal Flap during Primary Furlow Palatoplasty Decreases Likelihood of Velopharyngeal Insufficiency in Patients with Cleft Palate.

BACKGROUND

The use of buccal myomucosal flaps during primary palatoplasty has gained popularity, but the impact on surgical outcomes remains debated. This study evaluated whether the use of buccal flaps in primary Furlow palatoplasty for children with cleft lip/palate decreases the likelihood of developing velopharyngeal insufficiency (VPI).

METHODS

A retrospective cohort study of children with cleft lip/palate who underwent primary palatoplasty from 2015 through 2022 at a single institution was performed. Patients younger than 2 years at surgery who had primary Furlow alone (FA) or Furlow with buccal flap (FB) and had speech-language pathology (SLP) evaluation for VPI were included. Bayesian multivariable logistic regression was used to assess the posterior probability of VPI after FB.

RESULTS

Seventy-nine patients were included (68% FA and 32% FB). The median age at palatoplasty was 12 months (interquartile range, 11.25 to 13 months). Baseline characteristics were similar between groups. The median age at SLP assessment was 5 years (range, 3 to 7 years). VPI rates were higher in FA (26.4%) versus FB (8.0%) ( P = 0.08). Fistula rates were higher in FA (9.4%) compared with FB (0.0%) ( P = 0.17). Patients with VPI had a higher fistula rate (25.0% versus 1.6%; P < 0.01). After adjusting for Veau class and fistula, buccal flaps had an odds ratio of 0.4 (95% credible interval, 0.1 to 1.6) in VPI, with an 89% likelihood of decreasing the odds of VPI.

CONCLUSIONS

Buccal flaps in primary Furlow palatoplasty were associated with lower VPI and fistula rates, supporting their role in optimizing speech outcomes. They offer advantages as vascularized, autologous tissue; however, multi-institutional, randomized studies are needed to confirm these findings.