Is Nasal Mucoperiosteal Closure Necessary in Cleft Palate Repair?
ABSTRACT The goals of successful palate repair include optimizing speech and feeding, mitigating adverse maxillary growth effect, and avoiding fistulae. The necessity of vomerine and/or nasal-side mucosa repair has not been tested. The purpose of this study was to compare the outcome of palate repairs with and without nasal mucoperiosteal closure. The authors used the null hypothesis.
This was a retrospective analysis of consecutive cleft palate repairs performed between 2001 and 2004. Group 1 underwent two-layer repair (oral and nasal/vomerine mucoperiosteal flaps), and group 2 underwent one-layer closure (oral mucoperiosteal flaps) only. Both groups underwent double-opposing Z-plasty posteriorly. Demographic and perioperative outcome variables were recorded and compared statistically.
Group 1 consisted of 51 children (23 boys and 28 girls), and 80 percent were nonsyndromic. Group 2 included 29 patients (15 boys and 14 girls), and 72 percent were without an associated diagnosis. Age at repair was similar (20.80 and 15.17 months, respectively). Operative time was less for one-layer repair (84 versus 135 minutes) (p = 0.0001). Complications, length of stay, and follow-up length were similar between the two cohorts. Velopharyngeal dysfunction was rare in both groups. A single fistula occurred in each group. Anthropometric data revealed larger maxillary arc and tragus-subnasale lengths in group 2. Growth velocities were similar in both groups.
The goals of cleft palate repair can be efficiently achieved using a one-sided oral mucoperiosteal repair only. Omitting the nasal-side and vomer repair does not increase fistula formation or prove detrimental to velopharyngeal function, and may facilitate maxillary growth.
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ABSTRACT: Abstract ABSTRACT Closure of a palatal fistula, especially after multiple recurrences, remains a complex reconstructive problem. Salvage of a recurrent palatal fistula after a FAMM flap by use of the traditional waltzing (jumping, migration) principle of tubed pedicle flaps is presented and the principles discussed. KEY WORDS: cleft palate, cleft palate fistula, fistula, FAMM flap, waltzing transfer, tubed pedicle flap.The Cleft Palate-Craniofacial Journal 10/2011; DOI:10.1597/11-040 · 1.11 Impact Factor
- Journal of Plastic Reconstructive & Aesthetic Surgery 01/2012; · 1.47 Impact Factor
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ABSTRACT: Despite improvement to surgical techniques of cleft-palate surgery, palatal fistulas remain a challenge. Many surgical procedures have been described for repair of these fistulas either by using the local tissue or by importing a new tissue from adjacent areas. In this report, we describe our technique for closure of palatal fistula using double-breasted mucoperiosteal flaps based on the greater palatine artery. Eight patients with oronasal fistulas located in the posterior two-thirds of the hard palate following cleft-palate repair were treated by double-breasted mucoperiosteal flaps with an overlapping zone of 1-2 cm. All fistulas successively healed, none of our patients developed any significant postoperative bleeding, infection or fistula recurrence. Double breasated mucoperiostial flap is a simple successful option for correction of oronasal fistula.Journal of Plastic Reconstructive & Aesthetic Surgery 03/2012; 65(9):e237-40. DOI:10.1016/j.bjps.2012.02.011 · 1.47 Impact Factor