Abstract
Palatal necrosis after palatoplasty in patients with cleft palate is a rare but significant problem encountered by any cleft surgeon. Few studies have addressed this disastrous complication and the prevalence of this problem remains unknown. Failure of a palatal flap may be attributed to different factors like kinking or section of the pedicle, anatomical variations, tension, vascular thrombosis, type of cleft, used surgical technique, surgeon's experience, infection, and malnutrition. Palatal flap necrosis can be prevented through identification of the risk factors and a careful surgical planning should be done before any palatoplasty. Management of severe fistulas observed as a consequence of palatal flap necrosis is a big challenge for any cleft surgeon. Different techniques as facial artery flaps, tongue flaps, and microvascular flaps have been described with this purpose. This review article discusses the current status of this serious complication in patients with cleft palate.
Highlights
Severe complications in patients after cleft palate surgery are not common.Severe defects are characterized by extended deficiency of tissues usually wider than the primary cleft and presented as severe fistulas or absence of palatal tissue in worst cases (Figures 1 and 2).These defects are commonly in relation with loss of palatal tissue after palatal flap necrosis
Different etiologies have been described for the development of large defects after cleft palate repair like tension of the wound closure related to the surgeon’s performance and cleft width, infection, and hematoma formation; it appears that necrosis of the mucoperiosteal flap is the most common cause of this complication [29]
Controversy exists regarding the possible role of the artery’s injury since authors like Dorrance and Wardill used the ligation of the vascular pedicle as a regular procedure during their surgical techniques for primary cleft palate repair without flap necrosis [22, 23]
Summary
Severe complications in patients after cleft palate surgery are not common. Severe defects are characterized by extended deficiency of tissues usually wider than the primary cleft and presented as severe fistulas or absence of palatal tissue in worst cases (Figures 1 and 2). These defects are commonly in relation with loss of palatal tissue after palatal flap necrosis. Another study from Nigeria observed two cases of flap necrosis (1%) in patients with bilateral cleft palates [3]. Management of severe fistulas observed as a consequence of palatal flap necrosis is a big challenge for any cleft surgeon. This review article discusses the current status of this serious complication in patients with cleft palate
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