Cleft - Ultimate Treatment
Anterior nasal floor - 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 anterior nasal floor repair. 1. Not to repair the anterior nasal floor will lead to buccal and inter-alveolar oro-nasal fistulae. Delayed primary closure of such fistulae is much more challenging than a secondary oro-nasal fistulae repair of the hard and/or soft palate. 2. The repair of the anterior nasal floor avoids dislodgement of food and/or fluid from the oral into the nasal cavity and most other negative otorhinolaryngeal sequelae. 3. The anterior nasal floor lap creates a permanent ideal nasal layer to accommodate future bone transplants during secondary or tertiary osteoplasty. 4. Secondary closure of buccal and inter-alveolar oro-nasal fistula should only take place during the secondary osteoplasty at around nine years of age. Any attempt to create tissue for repair before this age will probable lead to midfacial growth disturbance (= dysgnathic growth). 5. The anterior nasal floor flap can also serve as a layer to cover a resorbable PdLAlLA plate, a means to facilitate alveolar arch growth and bone induction in a narrow alveolar cleft. 6. In bilateral CLAP cases the anterior nasal floor flap is larger in size in a modified Broadbent compared to the one for a Noordhoff-Trott lip-repair. 142