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

Abstract

The use of buccal myomucosal flaps during primary palatoplasty have gained popularity, yet their impact on surgical outcomes remains debated. This study evaluates whether using buccal flaps in primary Furlow palatoplasty for children with cleft lip/palate (CLP) decreases the likelihood of developing velopharyngeal insufficiency (VPI). A retrospective cohort study of children with CLP who underwent primary palatoplasty (2015-2022) at a single institution. Patients < 2 years old 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 assessed the posterior probability of VPI after FB. Seventy-nine patients were included (68% FA vs 32% FB). Median age at palatoplasty was 12 months (IQR: 11.25-13). Baseline characteristics were similar between groups. The median age of SLP assessment was 5 (3-7) years. VPI rates were higher in FA (26.4%) versus FB (8.0% FB) (p=0.08). Fistula rates were higher in FA (9.4%) compared to FB (0.0%) (p=0.17). Patients with VPI had a higher fistula rate (25.0% vs 1.6%, p<0.01). After adjusting for Veau class and fistula, buccal flaps had an odds ratio of 0.4 (95% credible interval: 0.1-1.6) in VPI, with an 89% likelihood of decreasing the odds of VPI. Buccal flaps in primary Furlow palatoplasty were associated with lower VPI and fistula rates, supporting their role in optimizing speech outcomes. While they offer advantages as vascularized, autologous tissue, multi-institutional, randomized studies are needed to confirm these findings.