Cleft - Ultimate Treatment
Hart palate repair - The ULTIMATE Clinical pearls To achieve the ultimate result various aspects have to be considered. Ignoring one or more of these aspects will lead to suboptimal aesthetic and functional results in hard palate (hP) repair. 1. Stripping muco-periosteal layer from the hard palate in uni- or bi-lateral CLAPs leads to midfacial growth disturbance or dysgnathia. This has to be avoided by all means. 2. In hPsP clefts, the dento-alveolar arch is a single unit. Therefore the hard palate can be repaired by partially stripping the mucoperiosteal layer from the palate. The flap width should not be less than 1.0X, and not exceed 1.5X of the hP cleft width, respectively. Furthermore, if teeth are present, the palatal gingival tooth margins should not be infringed. 3. In a V-shaped hPsP the cleft can be repaired during the same surgery. In a U-shaped hPsP the repair should be done in two surgical sessions to avoid possible formation of oro-nasal fistula. The hP is usually repaired 11 to 12 months after the sP. 4. In CLAP cases the cranially- or superiorly-pedicled vomer flap can be covered by a PdLAlLA-sheet to achieve palatal healing ideally without a possible central groove. Nevertheless an oro-nasal fistula might occur at the junction of the hP and sP. 5. In hPsP cleft cases, a hard palate cleft of 6 mm width or less, can be repaired with a single nasal mucosal layer with a PdLAlLA sheet.
Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...