Does the Buccal Fat Pad Flap Reduce Fistula Rates in Cleft Palate Repair?

Objective To investigate whether the use of buccal fat pad flap during cleft palate repair reduces the risk of post-operative palatal fistula formation. Design Retrospective analysis of cleft palate repairs undertaken by a single surgeon over the period 2013–2025. Setting Tertiary care institution in London. Patients Two hundred and seventy-seven patients (146 female, 131 male) who underwent cleft palate repair between 2013 and 2025 were included in the study. One hundred and seventy-three patients had an isolated cleft palate, 78 patients had a unilateral cleft lip and palate, and 26 patients had a bilateral cleft lip and palate. The range of cleft width treated was 3–22 mm. The standard surgical technique employed a Sommerlad style intravelar veloplasty with von Langenbeck releases where necessary. Interventions The utilization of pedicled buccal fat pad flap in primary cleft palate repairs. Main Outcome Measure(s) Development of post-operative palatal fistula. Results Among 277 patients, 21 (7.6%) patients developed a post-operative fistula, most commonly in Zone IV (52%). The fistula rate was 3.7% with buccal fat pad flap use compared with 8.5% without ( P = 0.39). Bayesian logistic regression showed a two-thirds reduction in the odds of fistula formation (odds ratio [OR] = 0.33; 95% credible interval [CrI]: 0.15–0.74), suggesting a high probability of a protective effect. Conclusions This study demonstrates that the use of buccal fat pad flaps in primary cleft palate repair is an effective adjunct associated with a reduced incidence of post-operative oronasal fistula.