Cleft Palate Repair without Lateral Relaxing Incision

Abstract

Background:The goals of successful palate repair include optimization of speech and feeding, avoidance of fistula formation, and mitigation of adverse maxillary growth. However, the effects of scar formation on maxillary growth have not been discussed in detail.Methods:Between November 2010 and December 2011, the palateplasty was performed for 24 patients with cleft palate (median age, 12 months; range, 11–18 months). In the velum, a symmetrical intravelar veloplasty with mucosal Z-plasty was performed on both the nasal and oral sides. In the hard palate, instead of lateral relaxing incisions, a 1-line mucoperiosteal incision along the cleft margins was designed with subperiosteal undermining in the entire palatine bone. The palatal mucoperiosteum was sutured together in the middle of the cleft, and the cleft was directly closed without lateral relaxing incisions. The patients were monitored for 6 months to 1.6 years.Results:None of the cases had issues concerning flap viability, and all palate repairs healed well. Postoperative results were satisfactory, without any complications such as dehiscence, perforation, or palatal fistula.Conclusions:The method presented in this article was effective, with successful palatal closure and without scar formation or mucosal defects along the alveolus. We conclude that minimum contracture of the hard palate was useful for not only mitigating adverse maxillary growth but also for orthodontics.

Modified double-opposing Z-plasty for patients with Veau I cleft palate

“…As we assessed the experience of a single senior surgeon working in a hospital considered as a high-volume center, [48] any extrapolation of the findings should be carried out with caution. Similar to previous studies, [30,[35][36][37][38][39][40][41][42][43][44][45] the intraoperative judgment and decisionmaking regarding the grade of tension in the midline and the need for lateral relaxing incision was subjective and dependent on the experience of each surgeon. Since, all patients were included in the last 3 years of practice, the clinical judgment of the senior surgeon can be considered constant in both the evaluated periods.…”

“…[30,[35][36][37][38][39][40][41][42][43][44][45] Most of the previous studies as well as the present investigation have reported only early outcomes such as surgeryrelated complications including the fistula rate, while others have also demonstrated satisfactory speech outcomes. [30,[35][36][37][38][39][40][41][42][43][44][45] Although some mixed results concerning long-term maxillary arch and/or midface status have been reported after minimal incision palatoplasty, this should still be the target of future investigations using only medial incision approaches. [30,[35][36][37][38][39][40][41][42][43][44][45] In these previous studies minimal incision or only medial incision repairs were addressed [30,[35][36][37][38][39][40][41][42][43]…”

“…[27,34] In the literature, different authors have described modified lateral relaxing incisions (e.g., only a small incision lateral to the hamulus) while others have reported palatoplasty without lateral relaxing incisions. [30,[35][36][37][38][39][40][41][42][43][44][45] Overall, the described benefits of these modified surgical approaches lies on the absence of exposed raw surface or healing by secondary intention, supposedly reducing perioperative contamination, bleeding, and pain and also minimizing postoperative scarring and bone growth interference. [30,[35][36][37][38][39][40][41][42][43][44][45] Most of the previous studies as well as the present investigation have reported only early outcomes such as surgeryrelated complications including the fistula rate, while others have also demonstrated satisfactory speech outcomes.…”

“…[30,[35][36][37][38][39][40][41][42][43][44][45] Although some mixed results concerning long-term maxillary arch and/or midface status have been reported after minimal incision palatoplasty, this should still be the target of future investigations using only medial incision approaches. [30,[35][36][37][38][39][40][41][42][43][44][45] In these previous studies minimal incision or only medial incision repairs were addressed [30,[35][36][37][38][39][40][41][42][43][44][45] some maneuvers adopted to optimize tension-free closure were similar to those detailed for the MIDOZ approach, while others (e.g., dissection of the alveolar region, tissues extending to the choanae and pterygoid plate) were not adopted in our patients. Because of the potential direct damage to the maxillary arch and/or to the dental germs secondary to the alveolar manipulation, we prefer to perform lateral relaxing incisions to achieve a freely movable oral flap according to the need of each patient.…”

“…We included only non-syndromic patients with Veau I cleft palate. As there are only medial incision techniques being applicable to the complete spectrum of clefts (Veau types I-IV), [30,[35][36][37][38][39][40][41][42][43][44][45] others may try to expand the criteria inclusion used here. As the muscle reconstruction was performed according to the previously described palatoplasty using small DOZ, we hypothesize that the speech outcomes will be similar to those previously reported, that is, an overall velopharyngeal insufficiency surgery rate of 5.5%.…”