Thanapaisal Chantaramon, Punyavong Pattama, Jenwitheesuk Kamonwan, Surakunprapha Palakorn, Winaikosol Kengkart
From the Plastic and Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University.
Plast Reconstr Surg. 2022 May 1;149(5):1180-1185. doi: 10.1097/PRS.0000000000009037. Epub 2022 Mar 14.
The buccal fat flap is an encapsulated mass originating from a specific fat tissue that is easily accessed and richly vascularized. The aim of this study was to report the effect of using the buccal fat flap on the oronasal fistula rate in primary palatoplasty.
A case-controlled study of 94 patients who underwent primary cleft palate repair. Patients were divided into two groups: (1) two-flap palatoplasty with buccal fat flap for coverage of lateral hard palate defect and (2) conventional two-flap palatoplasty. The incidence of oronasal fistula and postoperative complications were compared between groups. Multivariate analysis was performed to determine the risk factors of oronasal fistula development.
Forty-seven patients in each group demonstrated the same baseline characteristics. The buccal fat group showed a significant lower postoperative oronasal fistula rate (2.13 percent versus 21.28 percent, p = 0.008) and smaller fistula size (2 mm versus 4 mm, p = 0.049). A cleft width wider than 11.5 mm increased the odds ratio of fistula formation by 8.44-fold (p = 0.047), and the use of buccal fat protected against postoperative palatal fistula formation (OR, 0.08, p = 0.019).
The use of buccal fat flaps for lateral hard palatal defect coverage in primary palatoplasty can reduce the rate of postoperative palatal fistula, especially in cases of wide palatal cleft.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
颊脂垫是一种包裹性肿物，起源于特定的脂肪组织，易于获取且血供丰富。本研究的目的是报告在一期腭裂修复术中使用颊脂垫对口鼻瘘发生率的影响。
对94例行一期腭裂修复术的患者进行病例对照研究。患者分为两组：（1）采用双瓣腭裂修复术并使用颊脂垫覆盖硬腭外侧缺损；（2）传统双瓣腭裂修复术。比较两组口鼻瘘的发生率及术后并发症。进行多因素分析以确定口鼻瘘发生的危险因素。
每组47例患者具有相同的基线特征。颊脂垫组术后口鼻瘘发生率显著较低（2.13% 对 21.28%，p = 0.008），瘘口尺寸较小（2 mm对4 mm，p = 0.049）。腭裂宽度大于11.5 mm使瘘形成的比值比增加8.44倍（p = 0.047），使用颊脂垫可预防术后腭瘘形成（比值比，0.08，p = 0.019）。
在一期腭裂修复术中使用颊脂垫覆盖硬腭外侧缺损可降低术后腭瘘发生率，尤其是在腭裂较宽的病例中。
临床问题/证据级别：治疗性，III级
