Freeing and Stretching the Palatine Vessels From the Greater Palatine Foramen in Palatoplasty.

Abstract

The aim of this paper is to present how to free and stretch the palatine vessels from the greater palatine foramen in palatoplasty. After a mucoperiosteal flap is raised, periosteal elevator is passed behind the palatine vessels to detach the periosteum around the vessels. Then, a blunt right-angle instrument is placed behind the palatine vessels, and the vessels are pulled from the foramen in the superior aspect, slightly forward (63 degrees) and medially (19 degrees) according to the direction to the greater palatine canal (GPC). The nasal mucosa is also released from the hard palate and from the lateral pharyngeal wall. After dividing the palatal aponeurosis and elevating the anterior flap, the first suture is inserted through the nasal layer of the mucosa at the level of the posterior border of the hard palate (A suture). The nasal layer is approximated and sutured. After the closure of the buccal layer, the 2 posterior flaps are joined to the small anterior flap. Finally, A suture is tied. In 60 cases of pushback palatoplasty, the palatine vessels were stretched from the greater palatine foramen. In literatures, the length of GPC is 26.97mm. Anteroposterior diameter of the upper opening of GPC is 3.88mm. The angle between the vertical plane and the axis of GPC is 19.09 degrees. The angle between the transverse plane and the axis of GPC is 62.63 degrees. Probably, this information is the values obtained in adults. As a matter of fact, similar values were obtained in our study on this subject.