Palate Repair Techniques Research Articles

Cleft palate repair and variations

Cleft 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.

P.011 Advanced simulator of cleft palate repair techniques

P.011 Advanced simulator of cleft palate repair techniques

A technique for cleft palate repair.

The author has developed a technique of palate repair that combines minimal hard palate dissection with radical retropositioning of the velar musculature and tensor tenotomy. The repair is performed under the operating microscope. Results are reported for 442 primary palate repairs performed between 1978 and 1992 inclusive, with follow-up of at least 10 years. In 80 percent of these palate repairs, repair was carried out through incisions at the margins of the cleft and without any mucoperiosteal flap elevation or lateral incisions. Secondary velopharyngeal rates have decreased from 10.2 to 4.9 to 4.6 percent in successive 5-year periods within this 15-year period. Evidence from independent assessment of speech results in palate re-repair and submucous cleft palate repair suggests that this more radical muscle dissection improves velar function.

Early maxillary growth in complete cleft lip, alveolus and palate patients following Widmaier-Perko's, or a modified Furlow's technique of soft palate repair

Introduction: The aim was to study the differences in early maxillary growth following the use of two techniques for soft palate repair in complete cleft lip, alveolus and palate patients. Material and methods: Out of sixty-four primary soft palate repairs, two model samples (one of each) having been matched (gender, age, cleft type, maxillary anterior and posterior width at time of soft palate repair) were selected from the groups treated according either to Furlow or to Widmaier-Perko. The Wilcoxon Test for small samples was used to test for differences. Results: At the age of 4 years, posterior transverse cleft size was significantly smaller by 2.26 mm on average (SD 2.23) in the Furlow sample. The posterior maxillary segment had grown sagitally 1.5 mm (SD 0.76) more in the Furlow sample. At the age of 4 years, all other parameters, including inter-canine point and inter-tuberosity distances did not significantly differ between the two samples. Conclusion: Transverse posterior growth was not statistically different between the samples and seemed to be within normal limits in both. There was more sagittal growth in the posterior maxillary segment in the Furlow sample, possibly related to less fibrotic contracture in the posterior hard palate and the soft palate. The transverse posterior cleft size was more reduced in the Furlow sample. This could not be correlated with the techniques chosen to close the hard palate cleft at the age of 4 years.

Creating long-term benefits in cleft lip and palate volunteer missions.

The authors present their experience with 15 years of organizing cleft lip and palate surgical volunteer missions in Latin America. The history, basic principles, and objectives of Operation San Jose, a volunteer goodwill program from Christus St. Joseph Hospital in Houston, Texas, are covered. This report addresses the different problems encountered and solutions found. Following the principles set by Operation San Jose, CIRPLAST is a Peruvian foundation for plastic surgery that travels to remote areas in Peru, operating on patients with cleft lip and palate deformities. This report highlights the importance of working with local plastic surgeons and their residents, and emphasizes that the program should be organized by and the operations performed by accredited plastic surgeons and with the auspices and support of the national plastic surgery society and the local medical board. Operation San Jose promotes the creation of long-term benefits by offering a program to teach local surgeons cleft lip and palate repair techniques and to set up guidelines to organize local surgeons so that they can continue this effort by treating their own patients in their own countries.

A teaching device for Furlow palatoplasty.

The Furlow double-opposing z-plasty technique of palate repair has become a common treatment for cleft palate. The procedure is more complicated than other methods of palate closure and is difficult for the trainee to visualize; It is even more difficult for the layperson without prior understanding of the concept of z-plasty to understand. A simple, inexpensive, portable model is described that shows the key elements of the repair and can be used for parent, patient, student, and resident teaching.

A Teaching Device for Furlow Palatoplasty

The Furlow double-opposing z-plasty technique of palate repair has become a common treatment for cleft palate. The procedure is more complicated than other methods of palate closure and is difficult for the trainee to visualize; It is even more difficult for the layperson without prior understanding of the concept of z-plasty to understand. A simple, inexpensive, portable model is described that shows the key elements of the repair and can be used for parent, patient, student, and resident teaching.

Treatment of the cranio-maxillofacial malignant tumours

The effects on craniofacial growth of two different soft palate repair techniques in two-stage palatoplasty were investigated. This was a retrospective, cross-sectional cohort study of 68 children with non-syndromic, complete unilateral cleft lip and palate. Thirty-four patients were treated with the modified Furlow method (F-group) and the remaining 34 with the Widmaier–Perko method (P-group). Craniofacial growth was assessed by analyzing 12 angular and 12 linear measurements on lateral cephalograms. Composite facial diagrams from the two groups were compared with those of a control non-cleft group. Angular and linear measurements did not differ significantly between the two groups, implying that the craniofacial morphology was not affected by the difference in soft palate repair technique. However, small differences in anterior nasal spine and posterior nasal spine were found in cleft patients compared with controls. These findings suggest that the modified Furlow and Widmaier–Perko methods have a similar impact on craniofacial growth. Considering speech function, the modified Furlow method provides better craniofacial growth and speech function. However, the long-term effects of both methods on craniofacial growth after growth cessation remain to be determined.

Early cleft palate repair completed before the age of 16 weeks: observations on a personal series of 100 children

This paper is a review of a series of 100 children on whom the author carried out a cleft palate repair at or before they reached the age of 16 weeks. These children had tympanometry tests done before and after surgery. In the case of clefts of the primary and secondary palate, dental casts were taken. The author's personal technique of cleft palate repair is presented. Some of the early results are discussed along with thoughts on the effects on jaw development, speech and hearing of such early surgery.