Primary Palate Research Articles

Effectiveness of secondary furlow palatoplasty with buccal myomucosal flap in correction of velopharyngeal insufficiency in patients with cleft palate

ObjectivesThe main purpose of this study was evaluation of the effectiveness of secondary furlow palatoplasty with buccal myomucosal flap (FPBF) for the treatment of velopharyngeal insufficiency (VPI) in patients with a cleft palate who were treated with two flap palatoplasty (TFP) in their primary palate repair.Material and methodsTwenty-three medically free children aged 4–8 years with non-syndromic and previously repaired cleft palate via TFP participated in the study. All patients received secondary surgery following the technique of FPBF. Preoperative speech evaluation was done before the secondary repair and 3 months after the surgery using a hypernasal speech scale, speech intelligibility scale, and nasopharyngoscopy.ResultsA statistically significant improvement was observed regarding the degree of hypernasality and speech intelligibility while comparing the preoperative scores after the primary surgery to the postoperative scores after the secondary surgery.In addition, a statistically significant improvement was found in the nasopharyngoscopic assessment.ConclusionsThe incorporation of a buccal myomucosal flap with Furlow palatoplasty was successful in improving hypernasality, speech intelligibility, and nasopharyngoscopic scores in patients with cleft palate.Trial registrationclinicaltrials.gov (NCT05626933).Clinical relevanceThis technique might be the surgical technique of choice while treating patients who are suffering from VPI after cleft palate repair.

Outcomes of primary repair of cleft palate using sommerled intravelar veloplasty associated with velocardiofacial syndrome

ObjectivesVelocardiofacial syndrome, a prevalent microdeletion syndrome occurring in 1 in 2000–4000 live births, is marked by speech and language disorders, notably velopharyngeal dysfunction. This study investigates speech outcomes, nasometric and videofluoroscopic results before and after primary repair of cleft palate using the Sommerlad intravelar veloplasty (SIVV) technique within the Isfahan cleft care team for patients with velocardiofacial syndrome. MethodsEmploying a quasi-experimental design, 19 participants with velocardiofacial syndrome, who underwent primary cleft palate repair by the Isfahan cleft care team, were included through convenience sampling. Perceptual and instrumental outcomes were assessed pre-and post-operatively. Statistical analysis encompassed paired t-tests and the non-parametric Wilcoxon signed-rank test (p < 0.05). ResultsThe study identified no statistically significant differences between pre-and post-surgical speech outcome parameters and nasalance scores. Nonetheless, a significant distinction emerged in the velopharyngeal closure ratio based on fluoroscopic evaluation (p = 0.038). ConclusionThe efficacy of the SIVV technique in treating velopharyngeal dysfunction in velocardiofacial syndrome patients is inconclusive, demanding further research. Post-surgical speech outcomes are influenced by surgical technique, hypotonia, apraxia of speech, and surgery timing. Notably, an elevated velopharyngeal valve closure ratio, though anatomically indicative, does not exclusively predict surgical success.

Feeding Management and Palate Repair Timing in Infants with Cleft Palate with and without Pierre Robin Sequence: A Multisite Study.

Compare the feeding management practices in infants with cleft palate with and without Pierre Robin sequence (PRS) and determine if specific feeding difficulties or interventions predict delayed palate repair. Retrospective cross-sectional study. Seventeen cleft palate teams contributed data. 414 infants were included in this study: 268 infants with cleft palate only and 146 infants with cleft palate and PRS. Data were collected via parent interview and electronic health records. Outcomes for the primary objective included categorical data for: history of poor growth, feeding therapy, milk fortification, use of enteral feeding, and feeding difficulties. The outcome for the secondary objective was age in months at primary palate repair. Infants with PRS had a significantly higher prevalence of feeding difficulties (81% versus 61%) and poor growth (29% versus 15%) compared to infants with cleft palate only. Infants with PRS received all feeding interventions-including feeding therapy, milk fortification, and enteral feeding-at a significantly higher frequency. Infants with PRS underwent primary palate repair at a mean age of 13.55 months (SD = 3.29) which was significantly (P < .00001) later than infants with cleft palate only who underwent palate repair at a mean age of 12.05 months (SD = 2.36). Predictors of delayed palate repair included diagnosis of PRS as well as Hispanic ethnicity and a history of poor growth. These findings can be used to establish clinical directives focused on providing early, multimodal feeding interventions to promote optimal growth and timely palate repair for infants with PRS.

Two-stage palatal repair in non-syndromic CLP patients using anterior to posterior closure is associated with minimal need for secondary palatal surgery

ObjectiveThe aim of the present study was to assess the need for secondary palatal corrective surgery in a concept of palate repair that uses a protocol of anterior to posterior closure of primary palate, hard palate and soft palate.MethodsA data base of patients primarily operated between 2001 and 2021 at the Craniofacial and Cleft Care Center of the University Goettingen was evaluated. Cleft lips had been repaired using Tennison Randall and Veau-Cronin procedures in conjunction with alveolar cleft repair. Cleft palate repair in CLP patients was accomplished in two steps with repair of primary palate and hard palate first using vomer flaps at the age of 10–12 months and subsequent soft palate closure using Veau/two-flap procedures 3 months later. Isolated cleft palate repair was performed in a one-stage operation using Veau/two-flap procedures. Data on age, sex, type of cleft, date and type of surgery, occurrence and location of oronasal fistulae, date and type of secondary surgery performed for correction of oronasal fistula (ONF)and / or Velophyaryngeal Insufficiency (VPI) were extracted. The rate of skeletal corrective surgery was registered as a proxy for surgery induced facial growth disturbance.ResultsIn the 195 patients with non-syndromic complete CLP evaluated, a total number of 446 operations had been performed for repair of alveolar cleft and cleft palate repair (Veau I through IV). In 1 patient (0,5%), an ONF occurred requiring secondary repair. Moreover, secondary surgery for correction of VPI was required in 1 patient (0,5%) resulting in an overall rate of 1% of secondary palatal surgery. Skeletal corrective surgery was indicated in 6 patients (19,3%) with complete CLP in the age group of 15 – 22 years (n = 31).ConclusionsThe presented data have shown that two-step sequential cleft palate closure of primary palate and hard palate first followed by soft palate closure has been associated with minimal rate of secondary corrective surgery for ONF and VPI at a relatively low need for surgical skeletal correction.

Evaluation of the effect of palatoplasty on the quality of life and speech outcomes in patients with velocardiofacial syndrome.

Children diagnosed with velocardiofacial syndrome (VCFS) suffer from various disabilities. Palatal abnormalities, as well as speech and language impairment, adversely affect a child's quality of life (QoL) and are some of the most distressing aspects for the parents of these children. The present study aimed to explore the effect of palatoplasty on the health-related quality of life (HRQoL) and speech outcomes in children with VCFS. The study recruited 20 patients (N = 20) with VCFS and connected speech, aged 3 years or older, having either undiagnosed submucous cleft palate (SMCP) or velopharyngeal insufficiency (VPI), and requiring primary cleft palate surgery or revision surgery. Speech assessment was conducted prior to palatoplasty and 6 months after the surgery. Intelligibility and hypernasality were evaluated using the Cleft Audit Protocol for Speech - Augmented (CAPS-A). The parent proxy-report form of the Pediatric Quality of Life Inventory (PedsQL™) was used to evaluate and compare the HRQoL of the VCFS patients before and after palatoplasty. Significant improvement in the HRQoL scores was achieved after the surgery across all domains (physical, emotional, social, and school functioning), especially in the emotional and social dimensions (p < 0.000). The post-operative speech assessment based on CAPS-A demonstrated improvement in speech intelligibility and hypernasality in the majority of patients. Given that children with VCFS face various medical and social problems, suitable palatal interventions are beneficial, improving both the speech ability and QoL of these children.

Analysis of the Management of Cleft Lip Surgery with the Characteristics of Patients with Cleft Lips or Without Cleft Palatum in Nort Sumatra

Clefts are the most common type of congenital abnormality on the face. This condition can cause medical, psychological, and social problems in individuals and&#x0D; families. Several previous studies have yielded results in the form of a large number&#x0D; of cleft sufferers who come for treatment at a late age. This can affect the outcomeof the management given. The characteristics of cleft patients in Indonesia, especially in Medan City, are still very limited. Therefore, researchers have the desire to be able to do research in this field. patients with or without cleft palate who were managed by Smile Train Indonesia together with the Horas Sehat Foundation at hospitals in North Sumatra based on:(1) type of cleft, (2) location of the cleft defect, (3) Gender, (4) Treatment time, and (5) Type of operation. design. The sample for this study was secondary data on 193 cleft patients who were managed by Smile Train Indonesia together with the Horas Sehat Foundation at hospitals in North Sumatra in the 2017 – 2022 period. palate based on the type of cleft was labiognatopalatoschizis with a total of 115 patients (59.6%), based on the location of the defect was a unilateral defect (left side) of 98 patients (50.8%), based on gender was male with a total of 130 patients (67.4%), based on the time of treatment category was the late labioplasty category with a total of 54 patients (28%), and based on the type of surgery the most was the type of primary cleft palate repair surgery with a total of 56 people (29%). from previous studies.

Choice of Surgeons in Retractors used in Cleft Lip and Palate Surgery: An Original Research.

To ensure optimal exposure and enable precise tissue manipulation, cleft lip and palate abnormalities require surgical repair utilizing retractors. Different retractors may affect surgical outcomes; however, this is not yet evident. Examining surgeon preferences for retractors in cleft lip and palate surgery and assessing their impact on patient outcomes were the goals of this study. The patients who underwent primary cleft lip and palate repair were retrospectively analyzed. This study evaluated three widely used retractors: the Langenbeck, Gelpi, and Moult Mouth Gag retractors. This study looked at demographic information, surgical results (including scarring, aesthetic outcomes, and wound healing issues), and surgeon preferences for retractors. The study identified differences in surgical outcomes related to various retractor types. Both Group A (Langenbeck retractor) and Group B (Gelpi retractor) demonstrated similar favorable results, such as little wound healing issues, less scarring, and pleasing cosmetic results. The wound healing issues, scarring, and cosmetic outcomes were all worse in Group C (Moult Mouth Gag retractor). Retractors were not always preferred by surgeons doing cleft lip and palate surgery. The type of retractor had an impact on the surgical results; the Moult Mouth Gag retractor performed less well than the Langenbeck and Gelpi retractors. These results highlight the value of using evidence-based criteria to select retractors more effectively and enhance surgical methods for better patient outcomes in cleft lip and palate repair.

Alveolar Oral Layer Repair by Periosteal Grafts versus Maxillary Flaps and Gingivoperiosteoplasty: Techniques and Follow-up to Adolescence.

Alveolar periosteoplasty during primary repair of cleft lip is still a topic of debate due to the fear exacerbating maxillary retrusion. The authors present their experience with early closure of alveolar clefts. The study aims to analyze gingivoperiosteoplasty (GPP) by comparing the use of locoregional flaps versus distant grafts for reconstruction of the lower layer of the primary palate cleft. Seventeen infants underwent 22 alveolar cleft repairs. After nasal floor repair by nasal mucoperiosteum, the oral layer was repaired by maxillary or gingival periosteal flaps in seven patients with alveolar clefts less than or equal to 6 mm wide, and tibial or pericranial periosteal grafts in 10 patients with wider clefts. At teenage years, crossbites in three flap-GPP and three graft-GPP patients were compared with nine older adolescents without primary GPP. Alveolar clefts were perfectly sealed. Radiographs during the early 3 postoperative years showed new bone formation more posteriorly extended in patients who underwent graft-GPP. Teeth eruption and alveolar rigidity at the mixed dentition age eliminated the need for secondary bone grafting. The anterior crossbites in adolescent patients ranged between -2 and -14 mm; crossing was relatively smaller in patients with a younger age and without cleft palate. The mean crossbite was 7.2 mm in the six teenagers and 9.6 mm in the control cases. Graft-GPP may be a good alternative to flap-GPP, particularly for wide alveolar cleft repair. Maxillary retrusion is aggravated in patients with cleft palate and older age at assessment. GPP may not increase crossbite.

Divergent growth of the transient brain compartments in fetuses with nonsyndromic isolated clefts involving the primary and secondary palate.

Cleft lip/palate is a common orofacial malformation that often leads to speech/language difficulties as well as developmental delays in affected children, despite surgical repair. Our understanding of brain development in these children is limited. This study aimed to analyze prenatal brain development in fetuses with cleft lip/palate and controls. We examined in utero MRIs of 30 controls and 42 cleft lip/palate fetal cases and measured regional brain volumes. Cleft lip/palate was categorized into groups A (cleft lip or alveolus) and B (any combination of clefts involving the primary and secondary palates). Using a repeated-measures regression model with relative brain hemisphere volumes (%), and after adjusting for multiple comparisons, we did not identify significant differences in regional brain growth between group A and controls. Group B clefts had significantly slower weekly cerebellar growth compared with controls. We also observed divergent brain growth in transient brain structures (cortical plate, subplate, ganglionic eminence) within group B clefts, depending on severity (unilateral or bilateral) and defect location (hemisphere ipsilateral or contralateral to the defect). Further research is needed to explore the association between regional fetal brain growth and cleft lip/palate severity, with the potential to inform early neurodevelopmental biomarkers and personalized diagnostics.

Characteristics of patients with cleft lip and palate during the community services in East Nusa Tenggara, Indonesia, 2017-2018

Background: Cleft lip and palate is a congenital abnormality that occurs early in during embryonic development. This disorder can cause speech, hearing, malnutrition and mental and social development disorders. The prevalence of cleft lip and palate in the world varies greatly, with the highest incidence rate in Asia. Purpose: This research aims to determine the characteristics of patients with cleft lip and palate during the community services in East Nusa Tenggara, Indonesia, from 2017 to 2018. Methods: The type of research is descriptive research with a population of 48 patients who attended the community service event for cleft lip and palate surgery. Patient data characteristics were grouped based on age, gender, and cleft lip and palate type. Results: The distribution of patients with cleft palate was mostly aged 0-5 years (47%), the gender was the same between men and women (50%), and the most common type of cleft palate was cleft of the anterior (primary) palate (54%). Conclusion: Understanding cleft lip and palate patients in East Nusa Tenggara helps determine incidence rates and risk factors. This helps in customizing services, facilitating educational efforts, and involving the local government for effective community support.

Susceptibility of primary ovine dorsal soft palate and palatine tonsil cells to FMDV infection.

Foot and mouth disease (FMD) is a highly contagious viral disease affecting cloven-hoofed animals. This disease is one of the most important in animal health due to its significant socio-economic impact, especially in case of an outbreak. One important challenge associated with this disease is the ability of the FMD virus (FMDV) to persist in its hosts through still unresolved underlying mechanisms. The absence of relevant in vitro models is one factor preventing advancement in our understanding of FMDV persistence. While a primary bovine cell model has been established using cells from FMDV primary and persistence site in cattle, it appeared interesting to develop a similar model based on ovine anatomical sites of interest to compare host-pathogen interactions. Thus, epithelial cells derived from the palatine tonsils and the dorsal soft palate were isolated and cultured. Their epithelial nature was confirmed using immunofluorescence. Following monolayer infection with FMDV O/FRA/1/2001 Clone 2.2, the FMDV-sensitivity of these cells was evaluated. Dorsal soft palate (DSP) cells were also expanded in multilayers at the air-liquid interface to mimic a stratified epithelium sensitive to FMDV infection. Our investigation revealed the presence of infectious virus, as well as viral antigens and viral RNA, up to 35 days after infection of the cell multilayers. Further experiment with DSP cells from different individuals needs to be reproduced to confirm the robustness of the new model of persistence in multilayer DSP. The establishment of such primary cells creates new opportunities for FMDV research and analysis in sheep cells.

Predictors of fistula formation after primary palatoplasty

Background: The goal of cleft palate repair is to create a seal between the oral and nasal cavities while improving speech by creating a functional velum. Various surgical techniques are at the surgeon's disposal to achieve this. Unfortunately, this sometimes fails, leading to formation of oronasal fistula. Objective: This study aimed to determine the predictors of oronasal fistula (ONF) formation following primary cleft palate repair. Methodology: This prospective interventional study involved cleft palate patients recruited from the University of Port Harcourt Teaching Hospital. Basic demographics and clinical data of participants were recorded preoperatively while morphometric measurements were taken under general anaesthesia to determine Cleft Palate Index and Cleft width. Four surgeons performed the procedures, and three surgical techniques were employed. Participants were followed up for a mean period of 5 months. The occurrence, location, and fate of ONF were documented. Correlation between ONF and potential predictor variables was tested, and determinant(s) of fistula formation was explored. Data was analysed using IBM SPSS version 21.0 with statistical significance set at P &lt; 0.05. Result: Eighty-two participants with ages ranging from 9 months to 19 years completed the study. The initial incidence of ONF was 29.3% but 16.7% of these cases resolved spontaneously within 5 weeks. Cleft Palate Index, Cleft width, and time (age) of repair significantly correlated with occurrence of ONF. However, Cleft width was the only statistically significant (p = 0.049) individual determinant of fistula formation. Conclusion: In this study, Cleft width W is the most important predictor of ONF formation.

Characteristics of Charity Cleft Patients in Haulussy General Hospital 2017-2019

Cleft lip and palate is a common congenital disorder with an incidence of 1 per 300 live births of Asian descent. There is a lack of cleft epidemiological data due to the absence of plastic surgeons, patients were referred to other provinces or enlisted to charity programs. This paper aims to evaluate the characteristics of our cleft patients at Haulussy General Hospital, Ambon, Maluku from 2017 – 2019. This is a retrospective study of 69 patients treated at Haulussy General Hospital, Ambon, Maluku, charity program from 2017 – 2019. Age, gender, diagnosis, procedure, and nutritional status were collected. 52% of patients are male with a median age of 4 years (range: 3 months – 34 years). The most common diagnosis was complete cleft palate (n=19), and the rarest was microform cleft lip (n=1). Complete cleft lip is more common in males, while isolated cleft palate is more common in females. The median age for primary lip repair, lip revision, and primary palate repair/revision was 1 year, 4.5 years, and 8 years, consecutively. Among 32 patients assessed for nutritional status, 22% were malnourished (19% were underweight, and 3% were severely underweight). Lip repair was done in 28 patients, palate repair in 36 patients, and lip or palate revision in 16 patients. The main techniques used were Lazy S and von Langenbeck.This retrospective study at Haulussy General Hospital from 2017 to 2019 highlights predominant cleft cases and malnutrition among patients. The findings emphasize the importance of tailored interventions and comprehensive care for individuals with cleft lip and/or palate.

Analysis of risk factors affecting poor wound healing after primary cleft palate surgery.

To study the risk factors of poor wound healing after primary cleft palate surgery. In this study, 980 cases of congenital cleft palate treated by Sommerlad-Furlow in the Department of Cleft Lip and Palate Surgery of Sichuan University from 2017 to 2021 were continuously analyzed. Indicators included patient's age, gender, body weight, cleft palate type, width of the widest fistula, cleft palate index (width of the widest fistula/width at the posterior edge of the maxillary tubercle plane), preoperative white blood cell count, preoperative hemoglobin level, preoperative antibiotic use, doctor's seniority, use of relaxation incision, operation time, postoperative upper respiratory tract infection, and postoperative wound healing. The postoperative wound healing was divided into normal healing, delayed healing, and palatal fistula. Both delayed healing and palatal fistula were classified as poor healing. The factors that may affect the healing outcome of the palatal wound after primary cleft palate repair were analyzed using SPSS 26.0 software. A total of 825 patients (84.2%) had normal healing, 112 patients (11.4%) had delayed hea-ling, and 43 patients (4.4%) had palatal fistula. Doctor's seniority, width of the widest fissure, cleft palate index, and operation time influenced the wound healing effect after cleft palate surgery (P<0.05). Doctors with low seniority, wide width of the widest fistula, large cleft palate index, and long operation time were the risk factors of poor wound healing. Doctor's seniority, width of the widest fissure, cleft palate index, and operation time are related to the effect of healing effect after cleft palate surgery.

Modified Mucosal Reconstruction in Unilateral Complete Cleft of Lip and Primary Palate: Surgical Technique and Practical Strategies.

The nasal floor and intraoral lining reconstruction of unilateral complete cleft of lip and primary palate has sparsely been reported. Solution: This article combines the previously-described C-flap mucosal flap and inferior turbinate flap with the newly-described lateral nasal mucosal flap for the mucosal repair of this uncommon subtype of deformity. Valuable practical strategies are offered to optimize the surgical execution within a limited pediatric intranasal surgical access, targeting to minimize tissue trauma and bleeding.

Strip pharyngoplasty as a secondary functional surgery for persistent velopharyngeal insufficiency in cleft palate

Despite a satisfactory primary repair, velopharyngeal insufficiency (VPI) may be a sequel of soft palate clefts, resulting in hypernasality and phonation disorders. In order to increase the function of the pharyngeal flap during a secondary pharyngoplasty, we have developed a strip pharyngoplasty technique involving the middle constrictor muscle of the pharynx. This article describes the successive steps of the intervention and discuss its indications, advantages and limitations. Strip pharyngoplasty as a secondary functional surgery for persistent VPI after primary cleft palate repair is an attractive surgical procedure, particularly adapted to cases with defective muscle contraction by providing a muscle contingent in addition to the mucosal flap.

Buccal Fat Pad in Primary and Secondary Cleft Palate Repair: A Systematic Review of the Literature.

To review the evidence supporting the use of buccal fat pad (BFP) in primary and secondary cleft palate repair and its short- and long- term clinical outcomes. Systematic review conducted by 2 independent reviewers following PRISMA guidelines. Articles were identified from three databases (Pubmed/Medline, Embase and Web of Science). Search terms included "cleft palate", "palatoplasty", "palate repair", "buccal fat pad". Use of BFP in primary and secondary cleft palatoplasty. Primary outcomes were immediate postoperative complications, postoperative fistula, and maxillary growth. Secondary outcomes were palatal length, speech, and donor site morbidity. Ninety-one reports were retrieved after excluding duplicates. Twenty-three studies were included (13 case series and 10 comparative studies). Overall level of evidence was low. Randomized and non-randomized studies had a high risk of bias. In primary palatoplasty, BFP was more frequently used filling lateral relaxing incisions(57.4%), or in the hard-soft palate junction and covering mucosal defects(30.1%). In these patients, post operative fistula incidence was 2.8%. Two studies found wider transverse maxillary dimensions after BFP use. No higher incidence of bleeding, infection, dehiscence, or flap necrosis was reported. In secondary palatoplasty, no recurrent fistulas were reported for patients undergoing BFP for fistula repair. BFP appears to be associated with a favorable impact in fistula prevention and management, as well as in transverse maxillary growth. However, there is a high heterogeneity among studies, high risk of bias and overall low quality of evidence. More high-quality research with long-term follow-up is warranted.

'Suspension Palatoplasty' - A new Method of Primary Palate Repair for Speaking Un-Repaired Clefts.

To design a technique of palate repair with predictable Velo Pharyngeal (VP) closure and normal speech - 'Suspension Palatoplasty' in speaking unrepaired Cleft Palate (CP) patients. To evaluate the results of patients with CP operated using the technique of 'Suspension palatoplasty' from 2014 -2018 in terms of surgical complications and speech outcomes. An ambi-spective longitudinal clinical study. Comprehensive cleft care clinic in a private trust hospital. Patients above 6 years of age with isolated CP, cleft lip and palate (CLP), operated using 'Suspension Palatoplasty' technique between 2014 and 2018 were included with minimum follow up period of 5 years. Subjective speech evaluation was done by two speech therapists and analysed. Author designed the technique of 'Suspension Palatoplasty' which aims to suspend the soft palate repaired by 'Hybrid Palatoplasty' technique, close to the nasopharynx using narrow pharyngeal flap with the pedicle based superiorly at adenoids, for an acceptable VP closure. Speech outcome and surgical complications were assessed. Out of 94 cases operated with age ranging from 6 to 45 years, 59 (62.8%) had normal speech, 12 (12.8%) had articulation errors but with no Velo-Pharyngeal Insufficiency (VPI) and 23 patients (24.4%) had hypernasality/ nasal emission (Suspected VPI). None of them had difficulty in breathing but one patient had snoring. 'Suspension Palatoplasty' is a simple primary operation with excellent speech outcomes with no obstructive sequelae in patients with speaking unrepaired cleft palate.

Comparison of the Outcomes of Surgical Repair of Cleft Palate Performed by Modified Von Langenbeck and Bardach (Two-Flap Palatoplasty) Methods.

Cleft lip and cleft palate are one of the most common congenital craniofacial abnormalities in the skull and face. We aimed to investigate the prevalence of complications after primary cleft palate repair surgery, performed on patients referred to a children's hospital, and to use the information and results obtained from it to reduce the complications and improve the results of these surgeries. In this cross-sectional-analytical study, using a census sampling method, the medical records of 94 consecutive cleft palate patients treated in Abuzar Hospital in Ahvaz, southern Iran, in the years 2019 to 2021 were studied. The rate of postoperative complications during the first week in terms of wound opening and flap necrosis and one month later in terms of fistula formation after surgery were also extracted from the files. Ninety-four patients with congenital cleft palate (57.4% male and 42.6% female) were enrolled. The gap width in all studied patients was 14 ± 5 mm. The frequency of complications of surgical wound opening, flap necrosis, oronasal fistula and hypernasality in von Langenbeck group was 9.5%, 0.15% and 28.1% respectively, and in Bardach group was 9.5 %, 15% and 33.3% respectively. There were no significant differences between the two surgical methods in terms of postoperative complications. Besides, what is important in choosing a surgical method is the patient's clinical condition, the surgeon's experience and skill, and his choice.

Inverted flap lip plasty, Abbe's method, in the reconstruction of bilateral complete cleft lip sequelae: report of a case

This study presents the case of a female patient treated between the ages of 19 and 24 years, with sequelae of complete bilateral cleft lip and palate. Sequelae treated include upper lip incompetence due to low lip volume and length, absence of premaxilla (due to unknown cause), conditioning a large naso alveolar and naso palatal fistula in the region of the primary and secondary palate junction (Pittsburgh V), and finally, dental malocclusion due to prognathism condition. Aforementioned sequelae were treated through upper labial plasty at the expense of translocation of pedicled lower labial flap in the lower labial artery, using Abbe's method; upper anterior removable partial anterior dental prosthesis, with sealing of the nasal cavity, and finally, Intraoral bilateral sagittal split osteotomies of mandibular ascending ramus, in order to reduce prognathism.