Cleft Palate Repair Surgical Complications Following Buccinator Myomucosal Flap Surgery

Background: The buccinator musculomucosal flap was found to be a useful alternative for palatal fistula and velopharyngeal insufficiency repair. This surgical technique has become increasingly common in the surgical management of secondary cleft palate deformities during the last years; however, few studies have been published documenting associated postoperative complications. The present study was carried out to present a case series and describe observed surgical complications associated with this technique used by the authors. Methods: This is a retrospective outcome study of patients with sequels after primary cleft palate repair (palatal fistulas, flap necrosis, or velopharyngeal insufficiency) admitted to our center and operated by a single surgeon using the buccinator flap from 2017 to July 2024. A review of the literature for studies published until November 2024 was performed to evaluate postoperative complications after using this technique. Results: A total of 42 cleft palate patients with postoperative sequels have been operated using the buccinator musculomucosal flap by a single surgeon (P.R.P.) from 2017 to 2024. The most common cleft palate sequel after primary cleft palate repair in this series was the mucoperiosteal flap necrosis 10/42 (23.8%), velopharyngeal insufficiency 21/42 (50%) and palatal fistula 11/42 (26.19%). The most common complications after buccal myomucosal flap surgery were flap dehiscence and partial flap necrosis in 13 (30.95%) and 8 (19.04%) of patients, respectively. Conclusions: Buccinator (buccal) flap is an alternative for reconstruction of cleft palate sequels; however, their potential complications are not rare and should be prevented.