Asad Rauf, Tariq Latif, Nayyar Sultan, Sajid Hameed Dar.
Filling the Gaps in Cleft Palate Surgery.
Pak J Med Health Sci Jan ;6(3):783-5.

Back ground: The patients with orofacial clefts are prone to mid face hypoplasia. The surgery also contributes varying degree of fibrosis as stripping off of mucoperiosteal flaps produces ischemia. The raw area created heals by secondary intention adding element of contracture. In an attempt to promote blood supply to the raw areas and to decrease severity of fibrosis buccal pad fat is brought as a pedicled flap. The articles describes the technique and results of the series. Material and methods: This is a descriptive, observational study done over three and a half years in which forty cases of cleft palate are managed in two groups. In group A (20 cases) the raw area was packed with synthetic hemostatic gel or gauze impregnated with tincture benzoin Co. All the patients of group B (20 cases) received a flap of buccal fat pad to cover the raw area. Previously operated patients were excluded from the study. Different parameters as regards age, sex and complications are tabulated. Results: Majority of the patients were females (60% in group A Vs 50% Group B). Most of the patients were below three years (65% in each group) but one (5%) in group A and 2(10%) in group B were older than five years. The incidence of post-op bleeding is same (5%) in both group. One patient (5%) in group A had to be resuscitated for respiratory arrest due to dislodgement of gauze pack. Two (10%) patients in group B had protrusion of fat post operatively with one (5%) requiring repeat surgery to remove the excess fat. Four patients (20%) in group A had minor fistulae as compared to two (10%) in group B. While all the fistulae healed in group B two (10%) patients in group A needed repeat surgery. All the patients were followed up for 06 months with group B showing better results. Conclusion: The buccal fat pad is ideally located vascularilized tissue for palatoplasty. Though buccal fat pad is used extensively in reconstructive procedures no attempt has been made to define its role in primary palatal surgery. To promote blood supply to the raw area of palatal surgery buccal fat pad can play a major role thus minimizing the complication of mid face hypoplasia.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com