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PURPOSE: Use of buccal fat pad flaps (BFPF) in primary palatoplasty was recently shown to reduce the rate of secondary surgery, but the risk for development of obstructive sleep apnea (OSA) remains to be evaluated. We hypothesize that BFPF improves function of the soft palate and 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. 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 secondary surgery, and resolution of OSA with adenotonsillectomy (T/A). RESULTS: 206 patients met inclusion criteria. Of these, 101 had primary palatoplasty with BFPF. Incidence of OSA was 9.5% (n=10) and 10.9% (n=11) in the non-BFPF and BFPF groups, respectively (p=0.82). In the BFPF group, one patient developed OSA after secondary surgery, compared to seven in the non-BFPF group (p=0.0654). In the BFPF group, 62.5% (15 out of 24) had resolution of OSA with T/A, compared to 76.9% (20 out of 26) in the non-BFPF group (p=0.358). Neither quantity nor location of BFPF placement were risk factors for OSA. Pierre Robin sequence was the only significant predictor for development of OSA (p=0.0076). CONCLUSION: Placing BFPF at the time of primary palatoplasty was not associated with increased incidence of OSA. Notably, neither placement location nor quantity of harvested BFPF was a significant risk factor, suggesting that BFPF use is safe regardless of volume and configuration.
Sheppard et al. (Wed,) studied this question.