The Square Flap Method for Cleft Palate Repair

2007 ◽  
Vol 44 (6) ◽  
pp. 579-584 ◽  
Author(s):  
Jing-Hong Xu ◽  
Hong Chen ◽  
Wei-Qiang Tan ◽  
Jun Lin ◽  
Wei-Hua Wu
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Functional Disturbance ◽  
Speech Evaluation ◽  
Flap Viability ◽  
Velopharyngeal Closure ◽  
Different Types ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
New Surgical Technique

Objective: To introduce a new surgical technique for repair of cleft palate using the square flap method. Design and Setting: A retrospective analysis of prospectively collected data. Patients and Methods: The procedure was performed from 1995 to 2004 in 21 males and 16 females with cleft palates of different types; the patients had a median age of 6.0 years and an average age of 9.4 years (range from 22 months to 23 years). In these patients, the square flap method, consisting of one rhombic flap and four triangular flaps, designed on the soft palate across the defect, was applied to the von Langenbeck procedure. After incisions, the flaps were rotated and advanced, and each flap was inserted into the opposite side and then sutured. The patients were followed from 6 months to 2 years, the velopharyngeal closure was examined by nasopharyngeal fiberscope and/ or x-ray radiography, and a clinical speech evaluation was performed. Results: In all cases, no problem of flap viability was encountered and all healed well. The postoperative results were satisfactory without any complications such as dehiscence, perforation, palatal fistula, or functional disturbance. The velopharyngeal closure and clinical speech evaluation were satisfactory, and the effects of the operation were stable. Conclusions: The technique presented has been effective, with the advantages of palatal closure without tension, good muscular reconstruction, and sufficient lengthening of the soft palate.

Induced Velopharyngeal Fatigue Effects in Speakers with Repaired Palatal Clefts

2007 ◽  
Vol 44 (3) ◽  
pp. 251-260 ◽  
Author(s):  
Jerald B. Moon ◽  
David P. Kuehn ◽  
Grace Chan ◽  
Lili Zhao
Keyword(s):  
Cleft Palate ◽  
Muscle Activity ◽  
Regression Line ◽  
Pressure Load ◽  
Nasal Side ◽  
Velopharyngeal Closure ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Nasal Pressure ◽  
Force Data

Objective: To address whether speakers with cleft palate exhibit velopharyngeal mechanism fatigue and are more susceptible to muscle fatigue than are speakers without cleft palate. Methods: Six adults with repaired palatal clefts and mild-moderate hypernasality served as subjects. Velopharyngeal closure force and levator veli palatini muscle activity were recorded. Subjects were asked to repeat /si/ 100 times while an external load consisting of air pressure (0, 5, 15, 25, 35 cm H2O) was applied via a mask to the nasal side of the velopharyngeal mechanism. Fatigue was defined as a reduction in velopharyngeal closure force across the series of /si/ productions, as evidenced by a negatively sloped regression line fit to the closure force data. Results: Absolute levels of velopharyngeal closure force were much lower than those observed previously in speakers without palatal clefts. All subjects showed evidence of fatigue. Furthermore, all subjects demonstrated exhaustion, where they were unable to close the velopharyngeal port against the nasal pressure load. This occurred at pressure load levels lower than those successfully completed by speakers without cleft palate. Conclusions: In speakers with a repaired palatal cleft, the velopharyngeal closure muscles may not possess the same strength and/or endurance as in normal speakers. Alternatively, muscles may possess adequate strength, but not be positioned optimally within the velopharynx following cleft palate repair or may be forced to move velopharyngeal structures that are stiffer as a result of surgical scarring.

scholarly journals Perceptual and videofluoroscopic analyses of relation between backed articulation and velopharyngeal closure following cleft palate repair

2014 ◽  
Vol 11 (2) ◽  
pp. 60-67
Author(s):  
Masahiro Tezuka ◽  
Yuko Ogata ◽  
Kazuhide Matsunaga ◽  
Takeshi Mitsuyasu ◽  
Sachiyo Hasegawa ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Closure ◽  
Cleft Palate Repair ◽  
Palate Repair

Cleft Palate Repair

2019 ◽  
pp. 519-530
Author(s):  
Catharine B. Garland ◽  
Joseph E. Losee
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Postoperative Care ◽  
Cleft Palate Repair ◽  
History Of ◽  
Palate Repair ◽  
Alternative Techniques ◽  
Relationship Of ◽  
Normal Speech ◽  
Anatomic Relationship

Cleft palate repair is performed to allow for normal speech production, development, and social interactions. The goal of surgery is to restore the normal anatomic relationship of the tissues and muscles. The history of cleft palate repair has evolved from techniques that simply closed the mucosal layers to those that return the musculature of the palate to its normal anatomic position. A variety of techniques remain in common use today. This chapter reviews the relevant anatomy, preoperative and postoperative care, and the operative technique. The authors emphasize their preferred method of repair, the Furlow palatoplasty, and discuss in detail the steps for reconstruction of the hard and soft palate, with modifications as necessary to suit different cleft anatomy. Alternative techniques for cleft palate repair are reviewed in brief.

On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

2019 ◽  
Vol 56 (10) ◽  
pp. 1302-1313
Author(s):  
Ana Tache ◽  
Maurice Y. Mommaerts
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Oronasal Fistula ◽  
Type Iv ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Fistula Rate

Objective: The aims of the study were to assess the postoperative oronasal fistula rate after 1-stage and 2-stage cleft palate repair and identify risk factors associated with its development. Design: Systematic review. Setting: Various primary cleft and craniofacial centers in the world. Patients, Participants: Syndromic and nonsyndromic cleft lip, alveolus, and palate patients who had undergone primary cleft palate surgery. Intervention: Assessment of oronasal fistula frequency and correlation with staging, timing, and technique of repair, gender, and Veau type. The results obtained in this systematic review were compared with those in previous reports. Outcome: The main outcome is represented by the occurrence of the oronasal fistula after 1-stage versus 2-stage palatoplasty. Results: The mean fistula percentage was 9.94%. In the Veau I, II, III, and IV groups, the respective fistula rates were 2%, 7.3%, 8.3%, and 12.5%. Oronasal fistula locations based on the Pittsburgh Fistula Classification System were soft palate (type II), 16.2%; soft palate–hard palate junction (type III), 29.3%; and hard palate (type IV), 37.3%. There were no statistically significant differences between 1-stage and 2-stage palatoplasty, syndromic and nonsyndromic, or male and female patients. Primary palatoplasty timing was not a significant predictor. Conclusion: Some disparities arose when comparing studies, mainly regarding location and types of clefting prone to oronasal fistulation. Interestingly, the fistula rate does not differ between 1- and 2-stage closure, and timing of the repair does not play a role.

scholarly journals Cleft palate repair and variations

2009 ◽  
Vol 42 (S 01) ◽  
pp. S102-S109
Author(s):  
Karoon Agrawal
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
The Face ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Pharyngeal Flap ◽  
The One ◽  
Ideal Technique

ABSTRACTCleft 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.

scholarly journals Strategies to Improve Regeneration of the Soft Palate Muscles After Cleft Palate Repair

2012 ◽  
Vol 18 (6) ◽  
pp. 468-477 ◽  
Author(s):  
Paola L. Carvajal Monroy ◽  
Sander Grefte ◽  
Anne Marie Kuijpers-Jagtman ◽  
Frank A.D.T.G. Wagener ◽  
Johannes W. Von den Hoff
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Cleft Palate Repair ◽  
Palate Repair

Important points for primary cleft palate repair for speech derived from speech outcome after three different types of palatoplasty

2014 ◽  
Vol 78 (12) ◽  
pp. 2127-2131 ◽  
Author(s):  
Emi Funayama ◽  
Yuhei Yamamoto ◽  
Noriko Nishizawa ◽  
Tadashi Mikoya ◽  
Toru Okamoto ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Different Types ◽  
Cleft Palate Repair ◽  
Palate Repair

Sociodemographic Predictors of Patient Age at Time of Cleft Lip and Palate Repair

2020 ◽  
Vol 57 (12) ◽  
pp. 1402-1409
Author(s):  
Jeremy V. Lynn ◽  
Kavitha Ranganathan ◽  
Matthew H. Bageris ◽  
Alexandra O. Luby ◽  
Hailey R. Tursak ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Child Protective Services ◽  
Speech And Language ◽  
Protective Services ◽  
Patient Age ◽  
Speech Evaluation ◽  
Cleft Palate Repair ◽  
Cleft Lip Repair ◽  
Palate Repair

Objective: To identify the impact of sociodemographic and health variables on the age at which patients undergo cleft lip repair, cleft palate repair, and primary speech evaluation. Design: A retrospective, noninterventional quality assessment, and quality improvement study was designed. Setting: This institutional study was performed at Michigan Medicine in Ann Arbor, MI. Patients: All patients born between 2011 and 2014 who received surgical cleft repair, excluded those who were adopted (n = 165). Main Outcome Measure: The age at which patients undergo cleft lip repair, cleft palate repair, and primary speech evaluation. Results: Cleft lip repair was performed significantly later for patients identifying as Asian (18 weeks, P = .01), patients with Child Protective Services contact (19 weeks, P = .01), patients with a significant comorbidity (14 weeks, P = .02), and patients who underwent preliminary lip adhesion surgery (19 weeks, P < .01). Cleft palate repair was performed significantly later for patients identifying racially as Asian (19 weeks, P = .03) and other (22 weeks, P = .03). Preliminary speech and language evaluation were performed significantly later for patients identifying as black (55 weeks, P = .03) and patients diagnosed with an isolated cleft lip (71 weeks, P < .01). Conclusions: Timing of cleft lip, cleft palate repair, and primary speech and language evaluation are subject to variation which may be predicted by clinically accessible factors. By identifying race, Child Protective Services contact, and care variables as significant predictors of increased patient age at time of intervention, multidisciplinary cleft care teams can proactively allocate patient support resources.

A Computational Model of Velopharyngeal Closure for Simulating Cleft Palate Repair

2015 ◽  
Vol 26 (3) ◽  
pp. 658-662 ◽  
Author(s):  
Joshua M. Inouye ◽  
Catherine M. Pelland ◽  
Kant Y. Lin ◽  
Kathleen C. Borowitz ◽  
Silvia S. Blemker
Keyword(s):  
Cleft Palate ◽  
Computational Model ◽  
Velopharyngeal Closure ◽  
Cleft Palate Repair ◽  
Palate Repair
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