Investigation of the Anatomical and Physiological Changes Following the Use of a Pedicled Buccal Fat Pad Graft During Primary Palatoplasty

Abstract

Children with cleft palate typically undergo primary surgery between 6-12 months of age to close the cleft in the palate and create proper muscle function for elevation and retraction of the velum for speech. About one third of these children require secondary surgical intervention to eliminate hypernasal speech due to velopharyngeal dysfunction (VPD). However, it is currently inconclusive what factors influence the likelihood of developing VPD. A series of investigations were designed and implemented to explore post-surgical anatomical and physiological changes to the velopharynx. Study I identified differences in the levator veli palatini (levator) muscle of adults with cleft and non-cleft anatomy. Study II determined if there were any positional differences or asymmetry or within the velopharynx or levator muscle between children without cleft palate, those with cleft palate with complete velopharyngeal closure, and those with cleft palate and VPD. Lastly, study III sought to compare velopharyngeal anatomy and physiology among children with cleft palate who have undergone primary palatoplasty with buccal fat pad (BFP) graft placement to those who have undergone more traditional surgical methods as well as a normative control group. Data from study III, the final study, confirmed that those children who underwent BFP graft placement have a post-operative mechanism that is much different than that of children with traditionally repaired cleft palate as well as a normative group of peers. Significant differences were present for effective velar length, velar thickness, and percentage of fat tissue within the palate. This study confirms that the BFP material is present within the palate up to five years post-surgery and may create more favorable dimensions for velopharyngeal closure.