Repair of Complete Cleft Palate by Modified 2-Flap Palatoplasty

Koh, Kyung Suck; Kim, June kyu

Abstract

The goal of palatoplasty is focused on two points. One is to close the palatal defect completely and the other is to create velopharyngeal system for normal speech production. After palatoplasty, scaring of palatal bare area is an important factor contributing to maxillofacial growth aberration. Bardach reported that most palatal clefts could be closed without bare bone by using the two-flap palatoplasty. On the basis of clinical experiences of the two-flap palatoplasty, authors made the lateral incision on the noncleft side to decrease the chance of bony exposure. From November 2000 to January 2001, nine children with complete cleft palate underwent two-flap palatoplasty without lateral incision on noncleft side (modified two-flap palatoplasty). Mean age at cleft repair was 11.2 months, and mean follow-up period was 2.9 months. Incision was performed on the medial edges of both side and the alveolar ridge of the cleft side. After elevation, the mucoperiosteal flaps of both sides were rotated downward. The palatal gap was simply closed without tension. Palatal fistula did not occur, and there was no postoperative bleeding. Modified two-flap palatoplasty method can be suggested to reduce the bare bone exposure, scarring and resultant growth disturbance. However, more in-depth study by long term follow-up is needed to evaluate growth pattern and speech evaluation.