Buccal-Based Flap Techniques in Secondary Cleft Palate Surgery: A Scoping Review of Current Evidence and Research Gaps

Secondary cleft palate reconstruction is challenging because residual or recurrent complications after palatoplasty occur in scarred, tissue-deficient, poorly vascularized fields, and buccal-based flaps are increasingly used for oronasal fistula (ONF) repair and for velopharyngeal dysfunction or insufficiency (VPD/VPI). This scoping review, conducted according to Joanna Briggs Institute methodology and reported following the PRISMA extension for scoping reviews, aimed to map current evidence on buccal-based flap applications in secondary cleft palate reconstruction, including indications, techniques, reported outcomes, complications, and evidence gaps. PubMed, Scopus, Web of Science, and Google Scholar were searched for clinical studies published from January 2021 to June 2026. Ten studies were included: 6 addressed VPD/VPI, 3 addressed ONF repair, and 1 addressed mixed indications. Buccal mucosal and buccinator myomucosal flaps were used for multilayer ONF closure, palatal lengthening, velopharyngeal augmentation, or as adjuncts to revision palatoplasty. Oronasal fistula outcomes varied substantially; VPD/VPI studies reported improvements in velopharyngeal closure and speech, but comparative cohorts did not consistently show significant between-group differences. Reporting of complications, donor-site morbidity, and airway outcomes was inconsistent. Buccal-based flaps may have clinical utility as context-dependent options, but current evidence is limited and insufficient to establish procedural superiority; the small number of heterogeneous, predominantly observational studies is itself the principal finding, defining a clear evidence gap. Prospective comparative studies with standardised outcomes, systematic donor-site and airway assessment, longer follow-up, and clearer patient-selection criteria are needed.