Is nasal mucoperiosteal closure necessary in cleft palate repair?

Plastic Surgery, Yale University, New Haven, Conn., USA.
Plastic and Reconstructive Surgery (Impact Factor: 3.33). 02/2011; 127(2):768-73. DOI: 10.1097/PRS.0b013e3181fed80a
Source: PubMed

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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