Use of the Sphenoid Flap in Repair of the Wide Cleft Palate

Khan, Khurram; Hardwicke, Joseph; Seselgyte, Rimante; Morris, Paul; Thorburn, Guy; Kangesu, Loshan; Swan, Marc C.; Richard, Bruce

doi:10.1177/1055665617732781

Cited by 9 publications

(8 citation statements)

References 8 publications

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“…Autologous adjuncts included the use of the sphenoid flap (Khan et al, 2018) for closure of the nasal mucosa, increasing the extent of nasal dissection, using buccal fat or converting to a 2-stage procedure. A summary of the synthetic and autologous adjuncts used by consultants can be viewed in Table 2.…”

Section: Theme-surgical Variationmentioning

confidence: 99%

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Surgical Variation Between Consultant Surgeons Performing a Sommerlad Radical Intravelar Veloplasty

Butterworth

Hodgkinson

Sainsbury

et al. 2021

The Cleft Palate Craniofacial Journal

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Background: Although cleft surgeons in the United Kingdom follow a similar training pathway, and cleft centers adhere to similar protocols regarding timing of palate surgery and surgical technique, speech outcomes still vary significantly between centers. Objective: To explore if differences in technique exist between individual surgeons, performing a Sommerlad radical intravelar veloplasty (IVVP). Design: An exploratory, qualitative approach was adopted to understand the views of UK cleft surgeons performing a Sommerlad radical IVVP for primary cleft palate repair and to discuss what was important in the adoption, adaptation, and evolution of this technique within their own practice. Method: A semistructured interview schedule was designed. Interviews were conducted in person or via videoconferencing, with interested surgeons. The interviews were recorded, transcribed, and checked for accuracy. Analysis involved inductive thematic analysis. Results: Fourteen cleft consultants from the United Kingdom participated (3 females and 11 males). Seven of the consultants were trained in plastic surgery and 4 in oral and maxillofacial surgery. Eight themes were identified from the thematic analysis. One theme—Surgical Variation—is discussed. Conclusions: The findings provide insight into areas of variation seen within one surgical technique of cleft palate repair. These variations may have arisen to accommodate heterogeneity in the patient population or may have evolved in relation to different experiences of training or influences of colleagues. Further work is needed to explore the reasons for these differences in technique and to identify if any of these subtle differences contributed to variability in outcomes.

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Section: Theme-surgical Variationmentioning

confidence: 99%

“…The sphenoid flap has been reported to be useful in the repair of the wide cleft palate (Khan et al, 2018).…”

Section: Subthemementioning

confidence: 99%

Surgical Variation Between Consultant Surgeons Performing a Sommerlad Radical Intravelar Veloplasty

Butterworth

Hodgkinson

Sainsbury

et al. 2021

The Cleft Palate Craniofacial Journal

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“…Lateral incisions were necessary in 16% of the children with isolated cleft palate, 20% of the children with unilateral cleft lip and palate (UCLP), and 71% of the children with BCLP. The incidence of fistulae has also been reported to be higher in more extensive clefts (Sommerlad, 2003; Hardwicke et al, 2014; Khan et al, 2018). David et al's (2011) long-term study of individuals with BCLP indicated that they have worse speech outcomes than children with UCLP who had been cared for and assessed by the same team.…”

Section: Introductionmentioning

confidence: 97%

The Method of Surgical Lip Repair Affects Speech Outcomes in Children With Bilateral Cleft Lip and Palate

Peryer

Slator

Thomson

et al. 2020

The Cleft Palate Craniofacial Journal

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Objective: It was hypothesized that lip repair protocols in children with bilateral cleft lip and palate (BCLP) would affect development of bilabial consonants /m/ /b/ /p/. This study compared speech outcomes in 2 surgical groups. Design: A retrospective case note investigation. Setting: UK Cleft Centre (2000-2009). Patients: Forty-nine children with complete BCLP, of whom 26 had a 1-stage and 23 a 2-stage bilateral cleft lip repair. Interventions: One-stage cleft lip repair versus a 2-staged cleft lip repair. Main Outcome Measures: Bilabial consonant production at 18 months, 3 and 5 years of age. Cleft Speech Characteristics (CSCs) at age 5. Results: At age 18 months, 81% of the 1-stage lip repair group and 4% of the 2-stage lip repair group produced bilabial consonants ( P <·0001, Fisher test). At age 3 years, 81% of the 1-stage and 26% of the 2-stage lip repair groups produced bilabial consonants ( P =·0133, Fisher test). At age 5 years, both groups had similar bilabial consonant production, but children in the 2-stage lip repair group had more frequent and severe CSCs ( P = ·0037, χ2). Conclusion: A 1-stage lip repair for children with complete BCLP resulted in better bilabial consonant production at 18 months and 3 years of age than a 2-stage lip repair. At age 5 years both groups had bilabial consonants but children in the 2-stage lip repair group had worse CSCs. The surgical protocol for bilateral cleft lip repair affected speech outcome in children with BCLP.

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“…Even if a unilateral or bilateral vomerine flap is utilized to facilitate the closure of the nasal layer, there is still a high risk of fistula formation over the posterior limit of the septum due to dehiscence as a result of tension. If the nasal layer at the posterior limit of the septum is left to heal with secondary intention, scarring will cause the reconstructed velum to migrate anteriorly, resulting in velopharyngeal insufficiency [7].…”

Section: Introductionmentioning

confidence: 99%

Early outcomes of cleft and palatal width following anterior palate repair (vomerine flap) in infants with wide cleft lip and palate

et al. 2019

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BackgroundAnterior palatal repair performed during cleft lip repair using a vomerine flap may assist in recruiting additional soft tissue for subsequent completion of palatoplasty, especially in patients with a wide cleft. We present our early results in the hope of triggering a re-evaluation of this technique regarding its advantages for maxillary growth through further studies of patients with a wide cleft.MethodsA retrospective analysis of patients with complete unilateral and bilateral cleft lip and palate was performed, including cleft and palatal measurements taken during initial surgery (lip repair together with anterior palate repair) and upon completion of palatoplasty.ResultsIn total, 14 patients were included in this study, of whom nine (63.3%) had unilateral cleft lip and palate and five (37.5%) had bilateral cleft. All patients had a wide cleft palate. Lip and anterior palate repair was done at a median age of 3 months, while completion of palatoplasty was done at a median age of 10.5 months. Measurements taken upon completion of palatoplasty showed significant cleft width reduction in the mid-palate and intertubercle regions; however, the palatal arch distances at nearby landmarks showed non-significant marginal changes.ConclusionsAnterior palate repair using a vomerine flap significantly reduced the remaining cleft width, while the palatal width remained. Further research is warranted to explore the long-term effects of this technique in wide cleft patients in terms of facial growth.

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Use of the Sphenoid Flap in Repair of the Wide Cleft Palate

Cited by 9 publications

References 8 publications

Surgical Variation Between Consultant Surgeons Performing a Sommerlad Radical Intravelar Veloplasty

Surgical Variation Between Consultant Surgeons Performing a Sommerlad Radical Intravelar Veloplasty

The Method of Surgical Lip Repair Affects Speech Outcomes in Children With Bilateral Cleft Lip and Palate

Early outcomes of cleft and palatal width following anterior palate repair (vomerine flap) in infants with wide cleft lip and palate

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