Use of the buccinator musculomucosal flap for bone coverage in primary cleft palate repair.

BACKGROUND: Cleft palate is one of the most common congenital malformations in the maxillofacial region. After a cleft palate repair, surgeons must deal with the transverse growth restriction and palatal fistulas caused by scar tissue on the raw bone surface around the hard palate. This report describes the technique of the buccinator musculomucosal flap procedure performed together with repair of the cleft palate. The objective is to cover exposed bone areas of the hard palate to decrease scar contraction and subsequent transverse maxillary growth restriction, as well as tension at the closure.

METHODS: From August 2009 to February 2012, 15 patients underwent the buccinator musculomucosal flap procedure. First, the cleft palate was repaired by mucoperiosteal flaps, resulting in wide and raw bone surfaces around the hard palate. The outline of the flap was marked on the buccal mucosa. Grounding on the exposed bone areas around the hard palate, the authors designed widths of flaps ranging from 1.5 to 2.5 cm. These flaps were elevated from the buccopharyngeal fascia and turned 90° to cover the raw hard palate bone surfaces. The donor sites were closed by direct suture.

RESULTS: The follow-up period was 1-26 months (average, 10 months). No complications were found in any patient who underwent the procedure, and no fistulas occurred in the midline of the palate. No patients experienced complications related to the donor sites. No trismus or other dysfunction related to mouth movement was observed.

CONCLUSIONS: The buccinator musculomucosal flap is a convenient and safe flap procedure with fewer donor-site complications. This procedure also has significant potential for improving maxilla growth and reducing the secondary complications that often can result from cleft palate repair.

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