scholarly journals A novel modification of Bardach’s two-flap palatoplasty for the repair of a difficult cleft palate

2021 ◽  
Vol 48 (1) ◽  
pp. 75-79
Author(s):  
Mohd Altaf Mir ◽  
Nishank Manohar ◽  
Debarati Chattopadhyay ◽  
Sameer S Mahakalkar
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Surgical Techniques ◽  
Fistula Formation ◽  
Tension Free ◽  
Flap Technique ◽  
Oronasal Fistula ◽  
Free Closure ◽  
Microvascular Tissue Transfer ◽  
Difficult Cases

Bardach described a closure of the cleft utilizing the arch of the palate, which provides the length needed for closure and is most effective only in narrow clefts. Herein, we describe a case where we utilized Bardach’s two-flap technique with a vital and easy modification, done to allow closure of a wide cleft palate and to prevent oronasal fistula formation at the junction of the hard and soft palate, which are otherwise difficult to manage with conventional flaps. The closed palate showed healthy healing, palatal lengthening, and no oronasal regurgitation. We advise using this modification to achieve the goals of palatal repair in difficult cases where tension-free closure would otherwise be achieved with more complex flap surgical techniques, such as free microvascular tissue transfer.

What We Do: Greater Palatine Medializing Foraminal Osteotomy for Repair of the Wide Cleft Palate

2019 ◽  
Vol 56 (8) ◽  
pp. 1080-1082
Author(s):  
Theodore Pezas ◽  
Khurram Khan ◽  
Bruce Richard
Keyword(s):  
Cleft Palate ◽  
Speech Development ◽  
Fistula Formation ◽  
Secondary Surgery ◽  
Tension Free ◽  
Early Speech ◽  
Surgical Adjunct ◽  
Free Closure

Wide cleft palates (>15-mm gap) present a number of challenges to the surgeon tasked with their repair ( Bardach, 1999 ). Eliminating the need for secondary surgery due to fistula formation can reduce additional anesthetic and scarring risks and optimize early speech development. Greater palatine foraminal osteotomy is a useful surgical adjunct that allows additional medial movement of oral mucoperiosteal flaps to aid in tension-free closure of the oral layer. We use a technique similar to that described by Seibert in 1995 with a few modifications. Closure of the nasal layer in these wide clefts can be achieved using a sphenoid flap, a technique recently published by our unit ( Khan et al, 2018 ).

Cleft Palate Repair Using a Marginal Musculo-Mucosal Flap

2006 ◽  
Vol 43 (6) ◽  
pp. 651-655 ◽  
Author(s):  
Hisao Ogata ◽  
Tatsuo Nakajima ◽  
Fumio Onishi ◽  
Ikkei Tamada ◽  
Makoto Hikosaka
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Primary Repair ◽  
Formation Rate ◽  
Fistula Formation ◽  
Mucosal Flap ◽  
Periosteal Flap ◽  
Oronasal Fistula ◽  
Palate Repair

Objective: To describe a modified procedure consisting of a mucoso-periosteal flap palatoplasty with a marginal musculo-mucosal flap (3M flap). This is also the first report of a primary repair for complete cleft palate using the 3M flap. We describe the lengthening effect of the nasal mucous layer of the soft palate and evaluate the fistula formation rate associated with this method. Methods: This procedure has been performed on 21 patients with unilateral complete clefts and on 27 patients with incomplete clefts. A mucoso-periosteal flap raised from the hard palate was used mainly for closure of the cleft and not for the push-back. The 3M flap repaired the deficit of the nasal mucosa, making sure that the soft palate was lengthened. Intravelar veloplasty was performed also. Results: The dimension of the nasal mucosal defect that can be filled with the 3M flap is 10 to 12 mm in length, oriented anterior-posterior, and 15 to 20 mm wide. Oronasal fistula formation was recognized in only 3 of 48 cases (2 of 21 complete clefts, 1 of 27 incomplete clefts) and were located at the hard-soft palate junction at the anterior portion of the 3M flap. Conclusions: This method has the theoretical advantages of (1) preventing fistula formation by filling the tissue deficiency with the 3M flap; (2) achieving better velopharyngeal function due to elongation of the soft palate and retropulsion of the muscular bundle, utilizing the 3M flap; and (3) minimizing maxillary growth retardation by adopting a non–push-back method of hard palate repair.

Modified Von Langenbeck Cleft Palate Repair Using an Anterior Triangular Flap: Decreased Incidence of Anterior Oronasal Fistulas

2009 ◽  
Vol 46 (3) ◽  
pp. 299-304 ◽  
Author(s):  
Tara Lynn Stewart ◽  
David M. Fisher ◽  
Jaret L. Olson
Keyword(s):  
Cleft Palate ◽  
Anterior Margin ◽  
Fistula Formation ◽  
Anterior Portion ◽  
Oronasal Fistula ◽  
Triangular Flap ◽  
Secondary Palate ◽  
Nasal Side ◽  
Cleft Palate Repair ◽  
Hypernasal Speech

Objective: A complication following cleft palate surgery is the development of oronasal fistulas. Despite recent advances aimed at addressing this concern, rates of postoperative fistulas have remained unchanged and are reported at between 3% and 60%. Oronasal fistulas commonly occur between the hard and soft palate and at the anterior portion of the cleft. These fistulas lead to functional problems with nasal emission, hypernasal speech, and food regurgitation through the nose. For clefts of the secondary palate, we developed a modification of the Von Langenbeck technique in which an anterior triangular flap is used to decrease the incidence of postoperative fistulas. Method: A triangular flap composed of oromucosa was designed for isolated clefts of the secondary palate only. It is based at the anterior margin of the cleft and is used as a turnover flap to allow closure of the often very tight anterior nasal side. A retrospective chart analysis was performed from 2000 to 2007. All patients who had isolated clefts of the secondary palate and had undergone a modified Von Langenbeck procedure were included in the study. Patients were evaluated 4 to 8 weeks postoperatively for the presence of oronasal fistulas. Results: With the introduction of the anterior triangular flap, we show that 0 of 182 patients developed a postoperative oronasal fistula. Conclusions: This modification of the standard Von Langenbeck uses an anterior triangular flap and confers the advantage of assisting in nasal side closure of the anterior margin of the cleft; in doing so, it reduces the rate of fistula formation.

Oral Flora and Perioperative Antimicrobial Interventions in Cleft Palate Surgery: A Review of the Literature

2020 ◽  
pp. 105566562097736
Author(s):  
Miles J. Pfaff ◽  
Leila Musavi ◽  
Maxwell M. Wang ◽  
Christos S. Haveles ◽  
Claire Liu ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Antibiotic Use ◽  
Fistula Formation ◽  
Cochrane Library ◽  
Oral Flora ◽  
Oronasal Fistula ◽  
Perioperative Antibiotics ◽  
Antimicrobial Interventions ◽  
The Cochrane Library

Background: The role of perioperative antibiotics in cleft palate remains a topic of debate. Advocates stress their importance in preventing local and systemic infections and decreasing the incidence of oronasal fistula formation. However, few studies to date have directly evaluated the role of antibiotics and other antimicrobial measures in cleft palate surgery. Objective: The aim of this review is to evaluate the evidence surrounding the use of perioperative antibiotics and other antimicrobial interventions in cleft palate surgery. Additionally, we review the literature on the oral flora unique to the cleft palate patient population. Methods: This was accomplished utilizing PubMed, Medline, and the Cochrane Library with MeSH and generic terms. Articles were selected based on predefined inclusion and exclusion criteria. Results: This review highlights the lack of higher level evidence on perioperative antibiotic use and other antimicrobial interventions in cleft palatoplasty and calls for further research on the matter. Conclusions: The literature appears to support the use of preoperative antibiotics for cleft palatoplasty, but the benefits of prolonged postoperative antibiotic use remain questionable.

scholarly journals Does Hamulotomy during Palatoplasty Have Any Effect on Hearing Ability in Nonsyndromic Cleft Palate Patients? A Prospective, Single Blind, Comparative Study

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Anuj Jain ◽  
Pranali Nimonkar ◽  
Nitin Bhola ◽  
Rajiv Borle ◽  
Anendd Jadhav ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Middle Ear ◽  
Function Evaluation ◽  
Tension Free ◽  
Hearing Ability ◽  
Significant Difference ◽  
Tube Dysfunction ◽  
The Difference ◽  
Free Closure ◽  
Age Range

The primary goal of palatoplasty is to achieve a tension-free palatal closure ensuring no postoperative complications. Many surgeons fracture the pterygoid hamulus to minimize tension during palatoplasty. However, this maneuver gained criticism by some authors on the grounds that it may lead to Eustachian Tube dysfunction. Our study intended to figure out the relationship of hamulus fracture with the postoperative state of middle ear in cleft palate children. Fifty consecutive cleft palate patients with an age range of 10 months to 5 years were recruited. All the patients were assigned to either hamulotomy or nonhamulotomy group preoperatively. The patients were subjected to otoscopic examination and auditory function evaluation by brainstem evoked response audiometry (BERA) preoperatively and 1 month and 6 months postoperatively. Otoscopy revealed that the difference in the improvement of middle ear status in both groups was statistically insignificant. Moreover, there was no significant difference in the BERA outcomes of the fracture and nonfracture populations. Complication rate in both groups was also statistically not significant. It can be concluded that hamulotomy does not have any effect on the hearing ability in cleft palate population, so hamulotomy can be performed for tension-free closure during palatoplasty.

The Buccal Flap—A Useful Technique in Cleft Palate Repair?

2004 ◽  
Vol 41 (2) ◽  
pp. 144-151 ◽  
Author(s):  
Ian T. Jackson ◽  
Andrea A. Moreira-Gonzalez ◽  
Amy Rogers ◽  
Barbara J. Beal
Keyword(s):  
Cleft Palate ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Speech Quality ◽  
Fistula Formation ◽  
Study Cohort ◽  
Primary Care Center ◽  
Oronasal Fistula ◽  
Velopharyngeal Incompetence ◽  
Palate Repair

Objective To evaluate speech quality and oronasal fistula after primary palate repair using a buccal mucosal flap. Design Retrospective study cohort of patients with cleft palate. Setting Primary care center for treatment of craniofacial congenital anomalies. Patients and Method One hundred fifty-six nonsyndromic patients underwent palatoplasty with the buccal myomucosal flap by the senior surgeon between 1989 and 2002. The preoperative workup, surgical technique, and other factors that might affect the outcome were identical in every case. Oronasal fistula and variables affecting speech quality were analyzed. Results The most common type of cleft was unilateral cleft lip and palate (43.5%). The median follow-up was 5.8 years (0.4 to 21 years), and the median age at repair was 6.2 months. The overall fistula formation was 3.6%, decreasing progressively: 1989 to 1994: 2.9%, 1995 to 2002: 0.7% (p < .05). Velopharyngeal incompetence (VPI) occurred in 8.8% of the patients, decreasing from 5.3% to 3.5% in the last years. VPI and oronasal fistulae were observed mainly in unilateral and bilateral clefts of the lip and palate. Velopharyngeal adequacy occurred in 91.1% of the children, and resonance was normal in 91.1 %. None of the patients had severe hypernasality or hyponasality. Articulation was normal in 97.9% of the children. Speech quality was good in 89% of the patients. Conclusions The technique presented has been effective, with the advantages of palatal closure without tension, good muscular reconstruction, lengthening of the nasal layer, and palatal closure without raw areas. The technique, early repair, and surgeon's skills were the most important variables for good outcomes regarding speech and fistula formation.

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

2017 ◽  
Vol 55 (3) ◽  
pp. 437-441 ◽  
Author(s):  
Khurram Khan ◽  
Joseph Hardwicke ◽  
Rimante Seselgyte ◽  
Paul Morris ◽  
Guy Thorburn ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Fistula Formation ◽  
Street Hospital ◽  
Great Ormond Street Hospital ◽  
Secondary Intention ◽  
Small Defect ◽  
Increased Risk ◽  
Cleft Palate Repair ◽  
Multi Center Study

Objective: In wide palatal defects, closure of the nasal layer can prove a considerable challenge. Mobilizing nasal flaps posteriorly usually facilitates soft palate closure. However, the defect is often too wide within the hard palate; hence, bilateral vomerine flaps are frequently required. Despite this, there is often a small defect in the nasal layer at the posterior septum (typically equating to the hard-soft palate junction), which has to be left to heal by secondary intention with the resulting increased risk of fistula formation and the potential deleterious long-term effect on speech due to cicatricial migration of the reconstructed levator sling anteriorly. We describe our experience in the use of the sphenoid flap to obtain tension-free primary closure of the nasal layer. Methods: A retrospective multi-center study assessing all sphenoid flap procedures undertaken at both Birmingham Children’s Hospital and Great Ormond Street Hospital. Key demographic and medical data was collected pre-, peri-, and postoperatively across the 2 sites. Results: A total of 66 patients underwent the use of a sphenoid flap to aid closure of the nasal layer. The average age at time of repair was 9.7 months. More than half (55%, n = 36) were isolated cleft palates, and 35% (n = 23) were BCLPs. Forty-two percent of all patients had Robin sequence. The average cleft width was 14.4 mm. The overall fistula rate was 25.8% (n = 17). Conclusions: We describe the operative technique, indications, and our experience in the use of the sphenoid flap in wide cleft palate repair.

Reinforcing the Modified Double-Opposing Z-Plasty Approach Using the Pedicled Buccal Fat Flap as an Interpositional Layer for Cleft Palate Repair

2021 ◽  
pp. 105566562110647
Author(s):  
Rafael Denadai ◽  
Pang-Yun Chou ◽  
Lun-Jou Lo
Keyword(s):  
Cleft Palate ◽  
Middle Layer ◽  
Fistula Formation ◽  
Growth Disturbance ◽  
Full Coverage ◽  
Oronasal Fistula ◽  
Cleft Palate Repair ◽  
Single Intervention ◽  
Palate Repair ◽  
Relaxing Incisions

Pedicled buccal fat flaps have been adopted in primary Furlow double-opposing Z-plasty palatoplasty to reduce oronasal fistula formation or to attenuate maxillary growth disturbance. We combined both goals in a single intervention. This study describes a series of 33 modified Furlow small double-opposing Z-plasty palatoplasties reinforced with a middle layer of pedicled buccal fat flaps between the oral and nasal layers for full coverage of the dissected palatal surfaces, with rapid mucosalization of lateral relaxing incisions and no dehiscence or fistula formation.

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 Simultaneous Repair of Cleft Hard Palate by Vomer Flap along with Cleft Lip in Unilateral Complete Cleft Lip and Palate Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Kazi Md. Noor-ul Ferdous ◽  
M. Saif Ullah ◽  
M. Shajahan ◽  
M. Ashrarur Rahman Mitul ◽  
M. Kabirul Islam ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Operation Time ◽  
Fistula Formation ◽  
Posterior Border ◽  
Oronasal Fistula ◽  
Vomer Flap

The purpose of the study was to see the short-term outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP). A prospective observational study was carried out in 35 patients with unilateral complete cleft lip and palate who under-went cleft lip and cleft hard palate repair with vomer flaps simultaneously. After 3 months, cleft soft palate was repaired. During 1st and 2nd operations, the gap between cleft alveolus and posterior border of the cleft hard palate was measured. Postoperative complications, requirement of blood transfusion during the operation, and duration of operations were also recorded. Simultaneous repairs of cleft lip and closure of cleft hard palate with vomer flaps are easy to perform and are very effective for the repair of cleft lip and palate in UCLP patients. No blood transfusion was needed. Gaps of alveolar cleft and at the posterior border of hard palate were reduced remarkably, which made the closure of the soft palate easier, decreased operation time, and also decreased the chance of oronasal fistula formation.

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