What We Do: Greater Palatine Medializing Foraminal Osteotomy for Repair of the Wide Cleft Palate

2019 ◽  
Vol 56 (8) ◽  
pp. 1080-1082
Author(s):  
Theodore Pezas ◽  
Khurram Khan ◽  
Bruce Richard
Keyword(s):  
Cleft Palate ◽  
Speech Development ◽  
Fistula Formation ◽  
Secondary Surgery ◽  
Tension Free ◽  
Early Speech ◽  
Surgical Adjunct ◽  
Free Closure

Wide cleft palates (>15-mm gap) present a number of challenges to the surgeon tasked with their repair ( Bardach, 1999 ). Eliminating the need for secondary surgery due to fistula formation can reduce additional anesthetic and scarring risks and optimize early speech development. Greater palatine foraminal osteotomy is a useful surgical adjunct that allows additional medial movement of oral mucoperiosteal flaps to aid in tension-free closure of the oral layer. We use a technique similar to that described by Seibert in 1995 with a few modifications. Closure of the nasal layer in these wide clefts can be achieved using a sphenoid flap, a technique recently published by our unit ( Khan et al, 2018 ).

scholarly journals A novel modification of Bardach’s two-flap palatoplasty for the repair of a difficult cleft palate

2021 ◽  
Vol 48 (1) ◽  
pp. 75-79
Author(s):  
Mohd Altaf Mir ◽  
Nishank Manohar ◽  
Debarati Chattopadhyay ◽  
Sameer S Mahakalkar
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Surgical Techniques ◽  
Fistula Formation ◽  
Tension Free ◽  
Flap Technique ◽  
Oronasal Fistula ◽  
Free Closure ◽  
Microvascular Tissue Transfer ◽  
Difficult Cases

Bardach described a closure of the cleft utilizing the arch of the palate, which provides the length needed for closure and is most effective only in narrow clefts. Herein, we describe a case where we utilized Bardach’s two-flap technique with a vital and easy modification, done to allow closure of a wide cleft palate and to prevent oronasal fistula formation at the junction of the hard and soft palate, which are otherwise difficult to manage with conventional flaps. The closed palate showed healthy healing, palatal lengthening, and no oronasal regurgitation. We advise using this modification to achieve the goals of palatal repair in difficult cases where tension-free closure would otherwise be achieved with more complex flap surgical techniques, such as free microvascular tissue transfer.

scholarly journals Does Hamulotomy during Palatoplasty Have Any Effect on Hearing Ability in Nonsyndromic Cleft Palate Patients? A Prospective, Single Blind, Comparative Study

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Anuj Jain ◽  
Pranali Nimonkar ◽  
Nitin Bhola ◽  
Rajiv Borle ◽  
Anendd Jadhav ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Middle Ear ◽  
Function Evaluation ◽  
Tension Free ◽  
Hearing Ability ◽  
Significant Difference ◽  
Tube Dysfunction ◽  
The Difference ◽  
Free Closure ◽  
Age Range

The primary goal of palatoplasty is to achieve a tension-free palatal closure ensuring no postoperative complications. Many surgeons fracture the pterygoid hamulus to minimize tension during palatoplasty. However, this maneuver gained criticism by some authors on the grounds that it may lead to Eustachian Tube dysfunction. Our study intended to figure out the relationship of hamulus fracture with the postoperative state of middle ear in cleft palate children. Fifty consecutive cleft palate patients with an age range of 10 months to 5 years were recruited. All the patients were assigned to either hamulotomy or nonhamulotomy group preoperatively. The patients were subjected to otoscopic examination and auditory function evaluation by brainstem evoked response audiometry (BERA) preoperatively and 1 month and 6 months postoperatively. Otoscopy revealed that the difference in the improvement of middle ear status in both groups was statistically insignificant. Moreover, there was no significant difference in the BERA outcomes of the fracture and nonfracture populations. Complication rate in both groups was also statistically not significant. It can be concluded that hamulotomy does not have any effect on the hearing ability in cleft palate population, so hamulotomy can be performed for tension-free closure during palatoplasty.

scholarly journals Repair Exposure of the Postauricular Tissue Expander Using the Modified Brent Method: A 7-Year Experience

2021 ◽  
pp. 014556132110079
Author(s):  
Tongyu Cao ◽  
Qingguo Zhang
Keyword(s):  
Soft Tissue ◽  
Skin Flap ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Ear Reconstruction ◽  
Lower Pole ◽  
Tension Free ◽  
Subsequent Exposure ◽  
Free Closure ◽  
Complicated Conditions

Objectives: Ear reconstruction is a challenging surgery for the complicated conditions in patients with microtia. The tissue expansion techniques were necessary and relatively safe for patients with insufficient soft tissue. However, complications such as necrosis of expanded flap and exposure of tissue expander limited the popularization of this method. This study described the use of modified Brent method to handle the exposure of the postauricular tissue expander. Methods: From January 2013 to December 2019, 27 ear reconstruction patients with trauma or necrosis on an expanded skin flap and subsequent exposure of tissue expander were treated with modified Brent method, which consisted of 3 stages: removal of the expander, tension-free closure of wound, and framework fabrication; elevation of reconstructed ear; lobule rotation; and minor modification. Results: Fifty-six percent of exposures occurred in the lower pole of the tissue expander. Exposure usually occurred 54.5 days after implantation. The majority of reconstructed ears had a satisfactory appearance and showed relatively stable outcomes. Only one case of cartilage exposure required revision surgery and was repaired by the temporoparietal fascia. Conclusion: With reasonable distribution of expanded flap, prolonged interval, and sutures under tension-free conditions, complications like the occurrence of trauma or necrosis-induced exposure of tissue expander can be repaired efficiently by a staging modified Brent method.

Is Risk of Secondary Surgery for Oronasal Fistula Following Primary Cleft Palate Repair Associated With Hospital Case Volume and Cost-to-Charge Ratio?

2021 ◽  
Vol 58 (5) ◽  
pp. 603-611
Author(s):  
Giap H. Vu ◽  
Christopher L. Kalmar ◽  
Carrie E. Zimmerman ◽  
Laura S. Humphries ◽  
Jordan W. Swanson ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Outcome Measure ◽  
Charge Ratio ◽  
Fistula Repair ◽  
Case Volume ◽  
Secondary Surgery ◽  
Hospital Case ◽  
Oronasal Fistula ◽  
Cleft Palate Repair ◽  
Palate Repair

Objective: This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics—cost-to-charge ratio (RCC) and case volume of cleft palate repair. Design: Retrospective cohort study. Setting: This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. Patients and Participants: Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. Main Outcome Measure(s): The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. Results: Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P = .233; AOR = 0.86 [0.62-1.20], P = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P = .005; AOR = 3.14 [1.80-5.58], P < .001). Conclusions: Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.

Speech Development in Cleft Palate with and without Robin Sequence

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Andreas Naros ◽  
Sylva Bartel ◽  
Margit Bacher ◽  
Bernd Koos ◽  
Gunnar Blumenstock ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Speech Development ◽  
Robin Sequence

scholarly journals Management of Urethral Lesions and Urethrovaginal Fistula Formation Following Placement of a Tension-Free Suburethral Sling: Evaluation From a University Continence and Pelvic Floor Centre

2018 ◽  
Vol 78 (10) ◽  
pp. 991-998 ◽  
Author(s):  
Dorit Schöller ◽  
Sara Brucker ◽  
Christl Reisenauer
Keyword(s):  
Urinary Incontinence ◽  
Skin Flap ◽  
Vaginal Surgery ◽  
Mixed Urinary Incontinence ◽  
Fistula Formation ◽  
Anticholinergic Medication ◽  
Two Phase ◽  
Urethrovaginal Fistula ◽  
Tension Free ◽  
Tape Position

Abstract Introduction The complication of tape erosion in the urethra following placement of a retropubic (TVT) or transobturator (TOT) tension-free suburethral vaginal sling or an accidental iatrogenic transurethral tape position can result in the formation of a urethrovaginal or vesicovaginal fistula. The objective of the investigation is the evaluation of the management of such rare complications. Patients and Methods Retrospective analysis of 14 patients who were treated for a urethral lesion or urethrovaginal fistula formation status post TVT/TOT placement between June 2011 and February 2018 in the Tübingen University Department of Gynaecology. Results As surgical therapy, 57.1% (n = 8) cases underwent vaginal fistula closure using a Martius flap of the labium majus and in 21.4% (n = 3) using a vaginal rotation skin flap. In 21.4% (n = 3), exclusively vaginal suture reconstruction of the urethra following excision of the tape running transurethrally or tape erosion was performed. 50% (n = 7) of the patients had lasting continence postoperatively without any further need for therapy. In 28.6% (n = 4), there was ongoing stress urinary incontinence, in 21.4% (n = 3) mixed urinary incontinence. Six of the 7 patients with persistent incontinence underwent new placement of a tension-free suburethral retropubic sling (TVT) an average of 8.8 months (5 – 13 months) postoperatively which was uncomplicated in all patients and achieved satisfactory continence. The 3 patients with mixed urinary incontinence and persistent urgency components additionally received anticholinergic medication. During the time period investigated, there were no long-term complications, in particular no recurrent fistulas. Conclusion The rare but relevant complications of a urethral erosion, transurethral tape position or urethrovaginal fistula formation status post TVT/TOT placement can be successfully managed via vaginal surgery. Persistent postoperative urinary incontinence with the need for a two-phase repeat TVT placement following sufficient wound healing must be preoperatively clarified.

Combined Infrahyoid and Inferior Constrictor Muscle Release for Tension-Free Anastomosis during Primary Tracheal Repair

1992 ◽  
Vol 107 (3) ◽  
pp. 430-433 ◽  
Author(s):  
Hugh F. Biller ◽  
Michael A. Munier
Keyword(s):  
Success Rate ◽  
Operative Technique ◽  
Perioperative Management ◽  
Primary Repair ◽  
Primary Anastomosis ◽  
Management Problem ◽  
Tension Free ◽  
Constrictor Muscle ◽  
Free Closure ◽  
Combined Technique

Although tracheal stenosis is not a common clinical entity, it still presents a significant management problem, despite recent endoscopic advances. Surgical correction by resection and primary anastomosis is the preferred treatment, provided the repair can be performed without excessive tension. Various release techniques have been described in order to achieve mobility and, thereby, a tension-free anastomosis. This article presents a combined infrahyoid muscle and inferior constrictor muscle release to assure maximum mobility of the laryngotracheal complex, thus allowing tension-free closure. A series of ten patients who underwent primary repair using the combined technique is presented, and the operative technique is described. The indications, age, length of stenosis, and minimum 1 year followup of these patients are presented, as well as perioperative management and complications. The success rate with this technique is 90%.

Phonetic, Phonological, and Language Skills of Children with a Cleft Palate

2003 ◽  
Vol 40 (5) ◽  
pp. 460-470 ◽  
Author(s):  
Helen Morris ◽  
Anne Ozanne
Keyword(s):  
Language Development ◽  
Cleft Palate ◽  
Language Proficiency ◽  
Language Skills ◽  
Expressive Language ◽  
Speech Development ◽  
Group Differences ◽  
Language Abilities ◽  
Significant Group ◽  
Language Measures

Objective To evaluate the language, phonetic, and phonological skills at age 3 years of two groups of young children with a cleft palate, with different expressive language proficiency at 2 years of age. Design Two groups of children with a cleft palate with differing abilities in early expressive language skills were identified at age 2 years. Comparisons across groups were made over a range of speech and language measures at age 3 years. Participants Twenty children with cleft palate were allocated to two groups dependent on expressive language abilities at age 2 years. One group had normal language development, and the second group had been identified as having significantly delayed (8 to 12 months’ delay) expressive language development. Main Outcome Measures The children were assessed at 3 years of age using standardized assessments and spontaneous speech samples. Comparisons between the two groups were made on a range of language measures including comprehension, expressive language, and speech. Results Group differences were found on both language and speech abilities at age 3 years. Significant group differences were found in expressive language, percentage of consonants correct, phonetic inventory, and phonological process usage. The group with delayed early expressive language abilities at 2 years continued to have expressive language difficulties at 3 years of age and had more disordered speech development, compared with the nondelayed group. Conclusions A subgroup of children with a cleft palate was identified who exhibited delays in early expressive language and continued to have delayed language and disordered phonological patterns at a later age. Support for three possible etiologies including a structural/anatomical deficit, cognitive/linguistic delay, or language/phonological disorder are discussed.

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