SP27. Buccal Fat Pad Flaps In Cleft Palatoplasty Are Not Associated With Development Of Obstructive Sleep Apnea

Purpose: Congenital cleft palate is associated with increased risk for the development of velopharyngeal insufficiency (VPI) and obstructive sleep apnea (OSA). While the use of buccal fat pad flaps (BFPF) in primary palatoplasty was recently shown to reduce incidence of VPI, the impact on the development of OSA remains unstudied. OSA can lead to daytime somnolence, behavioral problems, and pulmonary hypertension, and it is important to ascertain potential risk for OSA with BFPF use. We posit that utilization of BFPF improves growth and physiologic function of the soft palate by mitigating scarring and palatal stiffness. We therefore hypothesize that primary palatoplasty with BFPF confers no greater risk for OSA than palatoplasty alone. Methods: A single center, retrospective chart review identified patients that underwent cleft palatoplasty with or without BFPF from 1995-2015. Data collected included age at time of surgery, Veau cleft classification, details of surgery, history of adenotonsillectomy (T/A), and length of follow-up. Patients with symptoms of OSA were evaluated by a pediatric sleep medicine specialist and underwent polysomnography. The primary outcome measure was development of OSA, defined as prescription of continuous positive airway pressure (CPAP) therapy. Secondary outcomes included development of OSA after speech surgery or fistula revision, and resolution of OSA symptoms with T/A. Results: 206 patients met inclusion criteria. Of these, 101 had primary palatoplasty with BFPF. The median age at palatoplasty was 1.15 years. The average duration of follow-up was 11.3 years. Incidence of OSA in the non-BFPF group was 9.5% (n=10) compared to 10.9% (n=11) in the BFPF group (p=0.82). In the BFPF group, 1 patient developed OSA after speech surgery. In the non-BFPF group, 5 patients developed OSA after speech surgery, and 2 patients developed OSA after surgical revision for palatal fistula. Of those patients requiring T/A in the BFPF group, 62.5% (15 out of 24) had resolution of OSA symptoms, compared to 76.9% (20 out of 26) in the non-BFPF group (p=0.358). In multiple logistic regression, Pierre Robin sequence was the only significant predictor for development of OSA (p=0.0076). Neither quantity of BFPF harvested (unilateral vs bilateral) nor BFPF location (over denuded palatal bone, or in the posterior palatal void created by the dissection between oral and nasal tissues) was associated with development of OSA. Conclusion: This study aimed to determine the risk associated with BFPF use, particularly the development of OSA. Placing BFPF at the time of primary palatoplasty was not associated with increased incidence of OSA. Fewer patients in the BFPF group developed OSA subsequent to surgeries for speech and fistula revision, suggesting that reduction in secondary surgeries could play a mediating role in keeping global risk for OSA to a minimum. Notably, neither placement location nor quantity of harvested BFPF was a significant risk factor, suggesting that BFPF are safe regardless of volume and configuration.