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.
Song et al. (Wed,) studied this question.