Optimizing Design and Mobility of Palatal Flaps in Repair of Wide Cleft Palate
Farouk, A., Abouarab, M. (2022). Optimizing Design and Mobility of Palatal Flaps in Repair of Wide Cleft Palate. EKB Journal Management System, 46(3), 205-210. doi: 10.21608/ejprs.2022.254692
Adham Farouk; Mohamed H. Abouarab. "Optimizing Design and Mobility of Palatal Flaps in Repair of Wide Cleft Palate". EKB Journal Management System, 46, 3, 2022, 205-210. doi: 10.21608/ejprs.2022.254692
Farouk, A., Abouarab, M. (2022). 'Optimizing Design and Mobility of Palatal Flaps in Repair of Wide Cleft Palate', EKB Journal Management System, 46(3), pp. 205-210. doi: 10.21608/ejprs.2022.254692
Farouk, A., Abouarab, M. Optimizing Design and Mobility of Palatal Flaps in Repair of Wide Cleft Palate. EKB Journal Management System, 2022; 46(3): 205-210. doi: 10.21608/ejprs.2022.254692

Optimizing Design and Mobility of Palatal Flaps in Repair of Wide Cleft Palate

The Egyptian Journal of Plastic and Reconstructive Surgery
Article 2, Volume 46, Issue 3, July 2022, Page 205-210  XML PDF (20.77 MB)
Document Type: Original Article
DOI: 10.21608/ejprs.2022.254692
View on SCiNiTO View on SCiNiTO
Authors
Adham Farouk email orcid ; Mohamed H. Abouarab email
The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Alexandria University
Abstract
Background: Wide cleft palate is a problem faced by
plastic surgeons. Many techniques have been described for
cleft palate repair, but not all of them can be used in cases of
wide cleft palate. The most common post-operative complication
is palatal fistula. Oronasal fistulae causes several
problems such as nasal food regurgitation, bad oral odor,
hypernasal speech. This study was performed to evaluate two
modifications of cleft palate repair techniques aiming to
decrease the rate of post-operative fistulae.
Patients and Methods: In this series of cleft palate patients,
we used the two flap palatoplasty technique combined with
an anterior triangular flap based anteriorly at the cleft margin
which is utilized as a turnover flap to decrease tension at the
anterior nasal mucosal layer especially in wide clefts. Moreover,
in wider clefts modifications such as greater palatine
osteotomy and mobilization of the flap pedicles were used to
provide more anterior and medial mobility of the flaps and
thus decreasing the tension at the suture line in the midline.
Results: The study included 20 patients. Healing of the
flap suture lines was uneventful. No complications were
recorded.
Conclusion: The two modifications of cleft palate repair
help to decrease tension during repair and thus decreasing the
incidence of palatal fistulae.
Keywords
Cleft palate; Fistula; Osteotomy; Greater palatine pedicle; Palatal flaps
References
1- Pezas T., Khan K. and Richard B.: What We Do: Greater
Palatine Medializing Foraminal Osteotomy for Repair of
the Wide Cleft Palate. The Cleft palate-craniofacial journal:
210 Vol. 46, No. 3 / Optimizing Design & Mobility of Palatal Flaps
Official publication of the American Cleft Palate-
Craniofacial Association, 56 (8): 1080-2, 2019.
2- Hardwicke J.T., Landini G. and Richard B.M.: Fistula
incidence after primary cleft palate repair: A systematic
review of the literature. Plastic and reconstructive surgery,
134 (4): 618e-27e, 2014.
3- Lu Y., Shi B., Zheng Q., Hu Q. and Wang Z.: Incidence
of palatal fistula after palatoplasty with levator veli palatini
retropositioning according to Sommerlad. The British
Journal of Oral & Maxillofacial Surgery, 48 (8): 637-40,
2010.
4- Murthy A.S., Parikh P.M., Cristion C., Thomassen M.,
Venturi M. and Boyajian M.J.: Fistula after 2-flap palatoplasty:
A 20-year review. Annals of Plastic Surgery, 63
(6): 632-5, 2009.
5- Tse R.W. and Siebold B.: Cleft Palate Repair: Description
of an Approach, Its Evolution, and Analysis of Postoperative
Fistulas. Plastic and Reconstructive Surgery, 141
(5): 1201-14, 2018.
6- Aboul-Wafa A.M.: Islandized mucoperiosteal flaps: A
versatile technique for closure of a wide palatal cleft. The
Canadian journal of plastic surgery Journal canadien de
chirurgie plastique, 20 (3): 173-7, 2012.
7- Stewart T.L., Fisher D.M. and Olson J.L.: Modified Von
Langenbeck cleft palate repair using an anterior triangular
flap: Decreased incidence of anterior oronasal fistulas.
The Cleft palate-craniofacial journal: Official publication
of the American Cleft Palate-Craniofacial Association,
46 (3): 299-304, 2009.
8- Salyer K.E, Sng K.W. and Sperry E.E.: Two-flap palatoplasty:
20-year experience and evolution of surgical
technique. Plastic and Reconstructive Surgery, 118 (1):
193-204, 2006.
9- Henningsson G., Kuehn D.P., Sell D., Sweeney T., Trost-
Cardamone J.E. and Whitehill T.L.: Universal parameters
for reporting speech outcomes in individuals with cleft
palate. The Cleft palate-craniofacial journal: Official
publication of the American Cleft Palate-Craniofacial
Association, 45 (1): 1-17, 2008.
10- Wu R., Cheraghlou S., Parsaei Y., Travieso R. and Steinbacher
D.M.: Does Cleft Palate Width Correlate With
Veau Classification and Outcome? The Journal of Craniofacial
Surgery, 28 (5): 1369-74, 2017.
11- Oh A. and Wong G.B.: An osteotome for outfracture of
the greater palatine foramen in cleft palate repair. Plastic
and Reconstructive Surgery, 107 (3): 820-2, 2001.
12- Farouk A.: Critical choices in cleft surgery: 18-year singlesurgeon
retrospective review of 900 cases. European
Journal of Plastic Surgery, 39 (1): 11-22, 2016

Statistics
Article View: 175
PDF Download: 278