A method of "unilateral operation" for early repair of unilateral complete cleft palate. Preliminary report

The Square Flap Method for Cleft Palate Repair

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.

The Single Z-Plasty for Cleft Palate Repair: A Preliminary Report

Objective

To introduce a surgical technique for the repair of cleft palate with the single and full-thickness Z-plasty method.

Patients and Methods

The procedure was performed from 1999 to 2006 in 34 patients with cleft palate with a median age of 6.0 years (range, 2.0 to 21 years). In these patients, in order to push the soft palate back farther, a single and full-thickness Z-plasty, designed on the soft palate across the defect, was applied to the von Langenbeck procedure. The full thickness of the soft palate was incised after the hard palate was closed by suturing the two mucoperiosteal flaps, and two Z-plasty flaps were formed. The two flaps were then transposed and closed by interrupted suturing of three layers of the palate in proper order, from nasal mucosa, levator muscle to oral mucosa. The patients were followed for 6 months to 3 years, velopharyngeal closure was examined by nasopharyngeal fiberscope and/or x-ray radiography, and a clinical speech evaluation was performed.

Results

In all patients, no problem of flap viability was encountered and all healed well. The postoperative results were satisfactory without any complications such as dehiscence, perforation, or palatal fistula. The clinical speech evaluation was satisfactory, and the effects of the operation were stable.

Conclusions

The technique presented has been effective, having the advantages of palatal closure without tension and with sufficient lengthening of the soft palate.