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: No definitive procedure for cleft repair has been identified yet as the gold standard. Accordingly, this work tried to appraise the hypothesis that if the bony detachment and full retropositioning of the levator veli palatini muscle can ideally present an anatomical C-shape muscular sling restoration and if this is accompanied with pushback palatoplasty, would this present a better result in terms of tissue fistulation and phonetic impairment? A series of 74 different degrees of palatal clefts were operated by pushback palatoplasty combined with a modified approach of the levator vili palatini. This muscle was dissected only from the oral mucosa while kept attached to the nasal one as a musculo-nasomucosal unit. This unit was completely detached from the bony margin of the hard palate and then medially rotated and retropositioned in a typical C-shape mobile sling. Evaluations included suture line assessment and fistula development, and following the child's need for speech therapy. There were no intraoperative complications. Definite anterior fistulae with nasal air and foot leakage were observed in 2 cases. Four cases had postoperative velopharyngeal incompetence with a need for speech therapy. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all cleft types, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this unpublished technique.The Journal of craniofacial surgery 11/2012; · 0.68 Impact Factor
Article: Cleft Palate Repair.[Show abstract] [Hide abstract]
ABSTRACT: The authors begin with a discussion of the anatomy relevant to palatoplasty. Perioperative considerations are then addressed. A broad range of surgical options has evolved over time; these are discussed in their historical context. The authors present a detailed description of their preferred surgical approach. Postoperative care is then described. An examination of recent trends and controversies in the field is then offered. Finally, an approach to outcomes assessment is discussed. It is hoped that this monograph will be of use in guiding others as they embark on the highly challenging, but equally rewarding, task of perfecting the palatoplasty.Clinics in plastic surgery 04/2014; 41(2):189-210. · 0.95 Impact Factor
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ABSTRACT: After studying this article, the participant should be able to: 1. Describe the technical details common to all cleft palate repairs that optimize outcomes and minimize complications. 2. Explain the subjective and objective evaluation of speech in children with cleft palate. 3. Practice with an increased awareness of the management of complications associated with cleft palate repair. 4. Design a treatment plan for velopharyngeal dysfunction.Plastic & Reconstructive Surgery 06/2014; 133(6):852e-64e. · 3.33 Impact Factor