Cleft Palate Repair Using a Marginal Musculo-Mucosal Flap

2006 ◽  
Vol 43 (6) ◽  
pp. 651-655 ◽  
Author(s):  
Hisao Ogata ◽  
Tatsuo Nakajima ◽  
Fumio Onishi ◽  
Ikkei Tamada ◽  
Makoto Hikosaka
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Primary Repair ◽  
Formation Rate ◽  
Fistula Formation ◽  
Mucosal Flap ◽  
Periosteal Flap ◽  
Oronasal Fistula ◽  
Palate Repair

Objective: To describe a modified procedure consisting of a mucoso-periosteal flap palatoplasty with a marginal musculo-mucosal flap (3M flap). This is also the first report of a primary repair for complete cleft palate using the 3M flap. We describe the lengthening effect of the nasal mucous layer of the soft palate and evaluate the fistula formation rate associated with this method. Methods: This procedure has been performed on 21 patients with unilateral complete clefts and on 27 patients with incomplete clefts. A mucoso-periosteal flap raised from the hard palate was used mainly for closure of the cleft and not for the push-back. The 3M flap repaired the deficit of the nasal mucosa, making sure that the soft palate was lengthened. Intravelar veloplasty was performed also. Results: The dimension of the nasal mucosal defect that can be filled with the 3M flap is 10 to 12 mm in length, oriented anterior-posterior, and 15 to 20 mm wide. Oronasal fistula formation was recognized in only 3 of 48 cases (2 of 21 complete clefts, 1 of 27 incomplete clefts) and were located at the hard-soft palate junction at the anterior portion of the 3M flap. Conclusions: This method has the theoretical advantages of (1) preventing fistula formation by filling the tissue deficiency with the 3M flap; (2) achieving better velopharyngeal function due to elongation of the soft palate and retropulsion of the muscular bundle, utilizing the 3M flap; and (3) minimizing maxillary growth retardation by adopting a non–push-back method of hard palate repair.

On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

2019 ◽  
Vol 56 (10) ◽  
pp. 1302-1313
Author(s):  
Ana Tache ◽  
Maurice Y. Mommaerts
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Oronasal Fistula ◽  
Type Iv ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Fistula Rate

Objective: The aims of the study were to assess the postoperative oronasal fistula rate after 1-stage and 2-stage cleft palate repair and identify risk factors associated with its development. Design: Systematic review. Setting: Various primary cleft and craniofacial centers in the world. Patients, Participants: Syndromic and nonsyndromic cleft lip, alveolus, and palate patients who had undergone primary cleft palate surgery. Intervention: Assessment of oronasal fistula frequency and correlation with staging, timing, and technique of repair, gender, and Veau type. The results obtained in this systematic review were compared with those in previous reports. Outcome: The main outcome is represented by the occurrence of the oronasal fistula after 1-stage versus 2-stage palatoplasty. Results: The mean fistula percentage was 9.94%. In the Veau I, II, III, and IV groups, the respective fistula rates were 2%, 7.3%, 8.3%, and 12.5%. Oronasal fistula locations based on the Pittsburgh Fistula Classification System were soft palate (type II), 16.2%; soft palate–hard palate junction (type III), 29.3%; and hard palate (type IV), 37.3%. There were no statistically significant differences between 1-stage and 2-stage palatoplasty, syndromic and nonsyndromic, or male and female patients. Primary palatoplasty timing was not a significant predictor. Conclusion: Some disparities arose when comparing studies, mainly regarding location and types of clefting prone to oronasal fistulation. Interestingly, the fistula rate does not differ between 1- and 2-stage closure, and timing of the repair does not play a role.

scholarly journals Oronasal fistula in cleft palate surgery

2009 ◽  
Vol 42 (S 01) ◽  
pp. S123-S128 ◽  
Author(s):  
Partha Sadhu
Keyword(s):  
Cleft Palate ◽  
Recurrence Rate ◽  
Surgical Procedures ◽  
Soft Palate ◽  
Hard Palate ◽  
Local Flaps ◽  
Oronasal Fistula ◽  
Palate Repair ◽  
Vascular Accidents ◽  
Nasal Regurgitation

ABSTRACTOronasal fistula (ONF) is the commonest complication associated with cleft palate surgery. The main symptoms associated with ONF are nasal regurgitation of food matter and hypernasality of voice. Repair of cleft palate under tension is considered to be the main reason of ONF though vascular accidents and infection can also be the cause. Most of the ONFs are situated in the hard palate or at the junction of hard and soft palate. Repair of ONF depends on its site, size and mode of presentation. A whole spectrum of surgical procedures starting from small local flaps to microvascular tissue transfers have been employed for closure of ONF. Recurrence rate of ONF is 25% on an average after the first attempt of repair.

The State of the Art in Cleft Palate Surgery

2000 ◽  
Vol 37 (3) ◽  
pp. 225-228 ◽  
Author(s):  
Don Larossa
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Surgical Repair ◽  
State Of The Art ◽  
Historical Context ◽  
Current Understanding ◽  
Multiple Methods ◽  
Advantages And Disadvantages ◽  
Palate Repair

Overview This update focuses on current practices and controversies in surgical repair of the hard and soft palate posterior to the alveolus. Our current understanding of the advantages and disadvantages of presurgical active and passive manipulation of the hard palate shelves including the use of periosteoplasty is reviewed. The evolution of the multiple methods of repair of the hard and soft palate is given in a historical context along with a discussion of the concerns about timing of palate repair.

The Buccal Flap—A Useful Technique in Cleft Palate Repair?

2004 ◽  
Vol 41 (2) ◽  
pp. 144-151 ◽  
Author(s):  
Ian T. Jackson ◽  
Andrea A. Moreira-Gonzalez ◽  
Amy Rogers ◽  
Barbara J. Beal
Keyword(s):  
Cleft Palate ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Speech Quality ◽  
Fistula Formation ◽  
Study Cohort ◽  
Primary Care Center ◽  
Oronasal Fistula ◽  
Velopharyngeal Incompetence ◽  
Palate Repair

Objective To evaluate speech quality and oronasal fistula after primary palate repair using a buccal mucosal flap. Design Retrospective study cohort of patients with cleft palate. Setting Primary care center for treatment of craniofacial congenital anomalies. Patients and Method One hundred fifty-six nonsyndromic patients underwent palatoplasty with the buccal myomucosal flap by the senior surgeon between 1989 and 2002. The preoperative workup, surgical technique, and other factors that might affect the outcome were identical in every case. Oronasal fistula and variables affecting speech quality were analyzed. Results The most common type of cleft was unilateral cleft lip and palate (43.5%). The median follow-up was 5.8 years (0.4 to 21 years), and the median age at repair was 6.2 months. The overall fistula formation was 3.6%, decreasing progressively: 1989 to 1994: 2.9%, 1995 to 2002: 0.7% (p < .05). Velopharyngeal incompetence (VPI) occurred in 8.8% of the patients, decreasing from 5.3% to 3.5% in the last years. VPI and oronasal fistulae were observed mainly in unilateral and bilateral clefts of the lip and palate. Velopharyngeal adequacy occurred in 91.1% of the children, and resonance was normal in 91.1 %. None of the patients had severe hypernasality or hyponasality. Articulation was normal in 97.9% of the children. Speech quality was good in 89% of the patients. Conclusions The technique presented has been effective, with the advantages of palatal closure without tension, good muscular reconstruction, lengthening of the nasal layer, and palatal closure without raw areas. The technique, early repair, and surgeon's skills were the most important variables for good outcomes regarding speech and fistula formation.

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.

Reinforcing the Modified Double-Opposing Z-Plasty Approach Using the Pedicled Buccal Fat Flap as an Interpositional Layer for Cleft Palate Repair

2021 ◽  
pp. 105566562110647
Author(s):  
Rafael Denadai ◽  
Pang-Yun Chou ◽  
Lun-Jou Lo
Keyword(s):  
Cleft Palate ◽  
Middle Layer ◽  
Fistula Formation ◽  
Growth Disturbance ◽  
Full Coverage ◽  
Oronasal Fistula ◽  
Cleft Palate Repair ◽  
Single Intervention ◽  
Palate Repair ◽  
Relaxing Incisions

Pedicled buccal fat flaps have been adopted in primary Furlow double-opposing Z-plasty palatoplasty to reduce oronasal fistula formation or to attenuate maxillary growth disturbance. We combined both goals in a single intervention. This study describes a series of 33 modified Furlow small double-opposing Z-plasty palatoplasties reinforced with a middle layer of pedicled buccal fat flaps between the oral and nasal layers for full coverage of the dissected palatal surfaces, with rapid mucosalization of lateral relaxing incisions and no dehiscence or fistula formation.

scholarly journals Simultaneous Repair of Cleft Hard Palate by Vomer Flap along with Cleft Lip in Unilateral Complete Cleft Lip and Palate Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Kazi Md. Noor-ul Ferdous ◽  
M. Saif Ullah ◽  
M. Shajahan ◽  
M. Ashrarur Rahman Mitul ◽  
M. Kabirul Islam ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Operation Time ◽  
Fistula Formation ◽  
Posterior Border ◽  
Oronasal Fistula ◽  
Vomer Flap

The purpose of the study was to see the short-term outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP). A prospective observational study was carried out in 35 patients with unilateral complete cleft lip and palate who under-went cleft lip and cleft hard palate repair with vomer flaps simultaneously. After 3 months, cleft soft palate was repaired. During 1st and 2nd operations, the gap between cleft alveolus and posterior border of the cleft hard palate was measured. Postoperative complications, requirement of blood transfusion during the operation, and duration of operations were also recorded. Simultaneous repairs of cleft lip and closure of cleft hard palate with vomer flaps are easy to perform and are very effective for the repair of cleft lip and palate in UCLP patients. No blood transfusion was needed. Gaps of alveolar cleft and at the posterior border of hard palate were reduced remarkably, which made the closure of the soft palate easier, decreased operation time, and also decreased the chance of oronasal fistula formation.

scholarly journals Cleft palate repair and variations

2009 ◽  
Vol 42 (S 01) ◽  
pp. S102-S109
Author(s):  
Karoon Agrawal
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
The Face ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Pharyngeal Flap ◽  
The One ◽  
Ideal Technique

ABSTRACTCleft palate affects almost every function of the face except vision. Today a child born with cleft palate with or without cleft lip should not be considered as unfortunate, because surgical repair of cleft palate has reached a highly satisfactory level. However for an average cleft surgeon palatoplasty remains an enigma. The surgery differs from centre to centre and surgeon to surgeon. However there is general agreement that palatoplasty (soft palate at least) should be performed between 6-12 months of age. Basically there are three groups of palatoplasty techniques. One is for hard palate repair, second for soft palate repair and the third based on the surgical schedule. Hard palate repair techniques are Veau-Wardill-Kilner V-Y, von Langenbeck, two-flap, Aleveolar extension palatoplasty, vomer flap, raw area free palatoplasty etc. The soft palate techniques are intravelar veloplasty, double opposing Z-plasty, radical muscle dissection, primary pharyngeal flap etc. And the protocol based techniques are Schweckendiek's, Malek's, whole in one, modified schedule with palatoplasty before lip repair etc. One should also know the effect of each technique on maxillofacial growth and speech. The ideal technique of palatoplasty is the one which gives perfect speech without affecting the maxillofacial growth and hearing. The techniques are still evolving because we are yet to design an ideal one. It is always good to know all the techniques and variations so that one can choose whichever gives the best result in one's hands. A large number of techniques are available in literature, and also every surgeon incorporates his own modification to make it a variation. However there are some basic techniques, which are described in details which are used in various centres. Some of the important variations are also described.

scholarly journals Nasal myiasis presented with palatal perforation: a Case report

2016 ◽  
Vol 3 (1) ◽  
pp. 56-59
Author(s):  
N Lageju ◽  
SC Shahi
Keyword(s):  
Case Report ◽  
Soft Palate ◽  
Nasal Septum ◽  
Hard Palate ◽  
Soft Tissues ◽  
Fistula Formation ◽  
Oronasal Fistula ◽  
Palatal Perforation ◽  
Nose And Paranasal Sinuses ◽  
Nasal Myiasis

Myiasis is rare disease of nose. In this case report we present a 47 years female with nasal myiasis along with palatal perforation which was managed conservatively with antibiotics, manual removal of maggots and planned for closure of oro-nasal fistula later. Later on the bleeding was gradually controlled. Patient was advised for imaging of nose and paranasal sinuses. The imaging showed soft tissues densities in the bilateral nasal cavity with erosion of nasal septum, hard palate and soft palate with oronasal fistula formation

Results of Randomized Controlled Trial of Soft Palate First versus Hard Palate First Repair in Unilateral Complete Cleft Lip and Palate

2006 ◽  
Vol 43 (3) ◽  
pp. 329-338 ◽  
Author(s):  
Bruce Richard ◽  
Joyce Russell ◽  
Siobhan McMahon ◽  
Ron Pigott
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Controlled Trial ◽  
Facial Growth ◽  
Cleft Closure ◽  
Palate Repair ◽  
Intercanine Distance

Objective To compare the outcomes for primary repair of unilateral cleft lip and palate, operating on the soft palate first versus the hard palate first. Design Randomized controlled trial. Setting The Regional Cleft Service of West Nepal. Patients Forty-seven consecutive patients with nonsyndromic unilateral cleft lip and palate, of whom 37 were assessed 4 to 6 years after completing primary surgical repair. Interventions Primary repair of unilateral cleft lip and palate by two differing sequences: (1) soft palate repair, with hard palate and lip repair 3 months later; and (2) lip and hard palate repair, followed by the soft palate repair 3 months later. Main Outcome Measures Analysis of dental study models, weight gain, and speech recordings. Results Four to 7 years after completing the cleft closure, there was no significant difference in facial growth between the two types of repair sequencing. Completing posterior repair first had no effect on anterior alveolar gap width. It narrowed the hard palate gap by reducing the intercanine distance. Anterior repair dramatically closed the anterior alveolar gap, and narrowed the intercanine distance. Comparing anterior alveolar gap width with age at first presentation demonstrated that there was no spontaneous narrowing of the cleft in older children. Completing posterior closure first had a weight gain advantage over anterior closure first. Improved oropharyngeal closure, and thus swallowing, is the likely explanation. Conclusion Changing the sequencing of cleft closure has no demonstrable difference in facial growth at 4 to 7 years after completion of the primary surgery.

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