This report describes a technical innovation for primary cleft palate repair utilizing the buccal fat pad flap in conjunction with the Furlow repair and the hard palatal two-flap procedure. This technique allows durable, autologous, and vascularized coverage of the denuded bony hard palate. In addition, the buccal fat pad flap functions to reinforce areas of high tension and decrease potential fistula formation. The buccal fat pad flap is simple and safe and has been used successfully in other intraoral reconstructions. We present 10 patients treated with this method for primary cleft palate repair, all of whom demonstrated full epithelialization within 2 weeks and showed no evidence of fistula formulation with 3months' followup. We also present four patients who had successful palatal fistula repairs without recurrence with 3 months follow-up. We believe cleft surgeons should add this innovative technique to their armamentarium for difficult cleft palate cases or fistula repair in which coverage of areas of high tension and denuded hard palate is of paramount importance.
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