Does Cleft Palate Width Impact Success of Cleft Repair?

Abstract

Objective: The safe and reliable reconstruction of composite mandibulectomy defects is a topic of significant interest. Unfortunately, a well-established small-animal model of the segmental composite mandibulectomy does not exist. We describe a reliable animal model that can be utilized to study mandibular reconstruction techniques, including atuogenous bone grafts and biomaterials.Method: Prospective analysis of survival-operations in the rat model (4-month Sprague Dawley Rattusnorvegicus). A detailed, stepwise description of surgical technique and relevant intraoperative anatomy is presented, utilizing photographic and radiographic images. Postoperative management, early pitfalls, surgical complications and future applications are discussed.Results: A total of 72 operations were performed by a single individual between July and October 2010. Two intraoperative and seven postoperative complications were recognized. There were 4 orocutaneous fistulas, 1 abscess, and 1 seroma. There were 3 fatalities; deaths were attributed to anesthetic complications (2, intraoperative) and foreign-body aspiration (1, postoperative). Conclusion:The novel animal model described here, reliably replicates the en-bloc segmental mandibular defects seen in our patient population. It can be manipulated to achieve a wide variety of research objectives, including the evaluation of biomaterials and tissue engineering techniques. Method: A prospective study of 232 patients with cleft palate repair from April 1995 to March 2010 at a tertiary care institution. The cleft palate was measured (mm) and repaired with a Furlow or 2-flap palatoplasty. Outcome measurements include fistula rate and secondary velopharyngeal insufficiency (VPI) repair. Facial Plastic and Reconstructive SurgeryResults: Primary cleft palate repair was performed on 232 patients by Furlow palatoplasty (n = 96) or 2-flap palatoplasty (n = 136). Patients were subdivided into 4 groups based on width: Group A 1 to 5 mm (n = 57), Group B 6 to 10 mm (n = 38), Group C 11 to 15 mm (n = 72), Group D 16 to 30 mm (n = 4). Fistula rates increase as the width of the palatal cleft increases. Fistula rates are similar between the Furlow and the 2-flap palatoplasty for each palatal width, except for clefts greater than 16mm. Two-flap palatoplasty has a higher rate of velopharyngeal insufficiency for all groups of cleft patients.Conclusion: At our institution the Furlow and 2-flap methods of palatoplasty have similar fistula rates for all cleft widths; however the Furlow method has decreased risk for subsequent velopharyngeal insufficiency compared with the 2-flap method. These data should encourage performance of the Furlow palatoplasty whenever feasible. Results: Eighty-seven cases involving the Double-Doyle intranasal airway splint technique performed for closed nasal reduction, selected cases of open rhinoplasty, and septal procedures revealed overall that this intranasal splint modification was safe, tolerated well by patients, and presented minimal morbidity. All but one patient expe...

A statistical analysis of incidence, etiology, and management of palatal fistula

“…Similar direct correlation between the both has also been documented by other authors. [151617] Contrary to this, Wilhelmi et al [18] and Mak et al [19] did not find any correlation between cleft width and fistula occurrence. In this study, we did not record the width of the cleft in cleft palate patients.…”