Surgical repair of cleft palate: With special reference to lengthening the soft palate

Abstract

The best result is obtained if the operaation for the surgical repair of a cleft palate is postponed until the child is between eighteen months and two years of age, or even older. The tissues are then in better condition to withstand the necessary manipulation and the mortality following operation is much lower than when performed at an earlier age. Early operation is of no advantage from the standpoint of speech improvement. The so-called “cleft palate speech” represents the inability of the child to prevent air from passing into the nose, especially in the articulation of consonants. From the anatomical and physiological standpoint, the von Langenbeck procedure with modifications, is the operation of choice to close the palate cleft. The soft palate should also be immobilized by the lead ribbon or tension relief wire, as an important requirement of the operation. The methods developed in the past few years for lengthening the velum, furnish a better functioning palate with improved articulation as an immediate result. In this connection, the procedure that retains the tissue intact covering the repaired bony cleft, offers a secure method for preventing an anterior perforation, especially as the bone is often cleft much farther anteriorly than indicated by the soft tissue defect.