Adeyemo Wasiu L, Ibikunle Adebayo A, James Olutayo, Taiwo Olanrewaju A
1Department of Oral and Maxillofacial Surgery, College of Medicine University of Lagos, Lagos, Nigeria.
2Department of Surgery, University of Sokoto, Sokoto, Nigeria.
J Maxillofac Oral Surg. 2019 Mar;18(1):40-45. doi: 10.1007/s12663-018-1100-9. Epub 2018 Mar 5.
The aim of the study is to describe the technique and also the outcome of using buccal fat pad (BFP) as an adjunct flap in cleft palate repair and to report the surgical outcome.
All the surgical repairs with BFP were done under general anaesthesia. The use of BFP was indicated in patients who needed a secondary palatal cleft repair, those with wide palatal clefts or patients whose primary palatal cleft repair was complicated intraoperatively by inadvertent tearing of the nasal mucosa. The raw wound surfaces were dressed with Vaseline gauze instilled with Framycetin. All subjects 4 years of age and below had oral toileting with warm saline-soaked gauze after each meal. The other patients had oral toileting with warm saline mouth bath in addition to conventional toothbrushing.
Eight patients were included in this study with an age range of 1-26 years (mean ± SD = 6.1 ± 8.6 years). Three patients presented with wide palatal clefts, another three presented with dehiscence after a primary repair which necessitated a secondary repair, while the remaining two patients had inadvertent iatrogenic tear of the nasal mucosa during the primary surgical repair. For the latter set of patients, repair was completed by the use of BFP as an adjunct at the same surgery. Post-operative evaluation was satisfactory in all cases, with healing of the flaps and complete epithelialization of the BFP in 1 month. All the patients experienced post-operative cheek swelling, signifying the post-operative oedema due to BFP harvest. However, this was usually resolved within 48 h. Healing was satisfactory with full epithelialization, and no complications were observed.
Successful application of BFP as an adjunct flap in palatal cleft closure is demonstrated in these series. It is recommended that cleft surgeons add this technique to their armamentarium in difficult cases, especially in wide palatal cleft repair, secondary palatal cleft repair and in cases of inadvertent tearing of nasal mucosa during primary cleft palate repair.
本研究旨在描述在腭裂修复中使用颊脂垫（BFP）作为辅助皮瓣的技术及效果，并报告手术结果。
所有使用BFP的手术修复均在全身麻醉下进行。需要二期腭裂修复、腭裂较宽或一期腭裂修复术中因意外撕裂鼻黏膜而出现并发症的患者适用BFP。创面用含硫酸新霉素的凡士林纱布覆盖。所有4岁及以下的受试者每餐饭后用温盐水浸泡的纱布进行口腔清洁。其他患者除常规刷牙外，还用温盐水漱口进行口腔清洁。
本研究纳入8例患者，年龄范围为1至26岁（平均±标准差=6.1±8.6岁）。3例患者为较宽的腭裂，另外3例在一期修复后出现裂开，需要二期修复，其余2例患者在一期手术修复过程中鼻黏膜意外医源性撕裂。对于后一组患者，在同一手术中使用BFP作为辅助完成修复。所有病例术后评估均满意，皮瓣在1个月内愈合，BFP完全上皮化。所有患者术后均出现面颊肿胀，表明因采集BFP导致术后水肿。然而，这种情况通常在48小时内消退。愈合情况良好，完全上皮化，未观察到并发症。
这些系列研究证明了BFP作为辅助皮瓣在腭裂闭合中的成功应用。建议腭裂外科医生在困难病例中，尤其是在较宽腭裂修复、二期腭裂修复以及一期腭裂修复过程中鼻黏膜意外撕裂的病例中，将该技术纳入其手术方法中。
