Speech outcomes following buccal fat pad interposition in palatal repair: A clinical outcome analysis

Cleft palate repair aims not only to achieve anatomical closure but also to restore normal velopharyngeal (VP) function essential for intelligible speech. Despite technical refinements, complications such as fistula formation, wound dehiscence, and persistent velopharyngeal insufficiency (VPI) continue to affect surgical success and speech outcomes. The buccal fat pad (BFP) has emerged as a reliable, well-vascularized graft for intraoral reconstruction, offering potential benefits in enhancing healing and speech function. To evaluate the effect of BFP interposition during Bardach two-flap palatoplasty on surgical healing, speech outcomes, and velopharyngeal competence in paediatric cleft palate patients. A prospective case series of 26 patients (17 males, 9 females; mean age 14 ± 2 months) with complete cleft palate underwent Bardach two-flap palatoplasty with BFP interposition between April 2022 and January 2024. Speech evaluations were performed preoperatively and at 3, 6, and 12 months postoperatively using age-appropriate perceptual assessments focusing on resonance, articulation, intelligibility, and VP competence. Postoperative complications, including fistula and donor site morbidity, were recorded. Data were analysed using SPSS v22, with significance set at p < 0.05. BFP provided a consistent, well-vascularized interpositional layer, resulting in satisfactory wound healing. Oronasal fistula occurred in 8% and wound dehiscence in 4% of cases. Donor site morbidity was minimal (4%) and resolved spontaneously. Hypernasality decreased from 76% preoperatively to 12% at 12 months, nasal air emission from 64% to 10%, and articulation errors from 70% to 14%, while speech intelligibility improved from 42% to 88% (p < 0.05). Adequate VP closure increased from 23% preoperatively to 88% postoperatively. BFP interposition during Bardach two-flap palatoplasty is a safe and effective adjunct for cleft palate repair. It enhances tissue healing, minimizes fistula formation, and significantly improves postoperative speech outcomes and velopharyngeal competence. Given its simplicity, minimal morbidity, and functional advantages, BFP-assisted palatoplasty represents a valuable technique in optimizing both structural and speech outcomes in cleft palate surgery.