All You Need is One: The Use of Buccal Flaps and Facial Asymmetry After Cleft Palate Repair

Introduction: The use of buccal flaps during primary palatoplasty may decrease the rate of complications such as dehiscence and fistula formation. This study aims to investigate if this use of buccal flaps results in perceived facial asymmetry of a patient. Methods: Photographs of patients with cleft palate who have undergone primary palatoplasty with unilateral, bilateral, or no buccal flaps at our institution were included in a de-identified survey. Respondents were asked to rate the facial asymmetry score (FAS) and which side appeared larger (cheek laterality score (CLS)). Results: The cohort included 21 patients: seven patients in each group (bilateral, unilateral, and no buccal flaps). Of these patients, 11 (52.4%) are male, and 10 (47.6%) are female. A total of 35 completed survey responses were received. The mean CLS (1 being bigger on the left and 5 being bigger on the right) was 2.79±0.48: 2.85±0.5 for bilateral buccal flaps, 2.66±0.54 for unilateral buccal flaps, and 2.88±0.43 for none ( P =0.7). Overall, the inter-rater reliability was good, using the intraclass correlation coefficient. On multivariate analysis, neither the FAS nor the CLS was significantly associated with the number of buccal flaps used. Discussion: There was no significant difference between the perceived asymmetry of patients' status post-primary cleft palate repair. This suggests that patients can safely undergo palatoplasty with unilateral or bilateral buccal flaps without the concern for aesthetic impacts on facial symmetry.