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DOI: 10.5999/aps.2019.00227
Early outcomes of cleft and palatal width following anterior palate repair (vomerine flap) in infants with wide cleft lip and palate
Background Anterior palatal repair performed during cleft lip repair using a vomerine flap may assist in recruiting additional soft tissue for subsequent completion of palatoplasty, especially in patients with a wide cleft. We present our early results in the hope of triggering a re-evaluation of this technique regarding its advantages for maxillary growth through further studies of patients with a wide cleft.
Methods A retrospective analysis of patients with complete unilateral and bilateral cleft lip and palate was performed, including cleft and palatal measurements taken during initial surgery (lip repair together with anterior palate repair) and upon completion of palatoplasty.
Results In total, 14 patients were included in this study, of whom nine (63.3%) had unilateral cleft lip and palate and five (37.5%) had bilateral cleft. All patients had a wide cleft palate. Lip and anterior palate repair was done at a median age of 3 months, while completion of palatoplasty was done at a median age of 10.5 months. Measurements taken upon completion of palatoplasty showed significant cleft width reduction in the mid-palate and intertubercle regions; however, the palatal arch distances at nearby landmarks showed non-significant marginal changes.
Conclusions Anterior palate repair using a vomerine flap significantly reduced the remaining cleft width, while the palatal width remained. Further research is warranted to explore the long-term effects of this technique in wide cleft patients in terms of facial growth.
Publication History
Received: 20 February 2019
Accepted: 24 September 2019
Article published online:
25 March 2022
© 2019. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
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REFERENCES
- 1 Lin KY, Black JS, Wang JS. et al. An outcome study of a 2-flap pushback palatoplasty used in the treatment of wide cleft palates. J Craniofac Surg 2015; 26: 620-4
- 2 Friede H. Maxillary growth controversies after two-stage palatal repair with delayed hard palate closure in unilateral cleft lip and palate patients: perspectives from literature and personal experience. Cleft Palate Craniofac J 2007; 44: 129-36
- 3 Liau JY, Sadove AM, van Aalst JA. An evidence-based approach to cleft palate repair. Plast Reconstr Surg 2010; 126: 2216-21
- 4 Bardach J. Book Salyer and Bardach’s atlas of craniofacial and cleft surgery. Vol. II: Cleft lip and palate surgery. Philadelphia: Lippincott-Raven; 1999
- 5 Aboul-Wafa AM. Islandized mucoperiosteal flaps: a versatile technique for closure of a wide palatal cleft. Can J Plast Surg 2012; 20: 173-7
- 6 Bumsted RM. A new method for achieving complete two-layer closure of a massive palatal cleft. Arch Otolaryngol 1982; 108: 147-50
- 7 Khan K, Hardwicke J, Seselgyte R. et al. Use of the sphenoid flap in repair of the wide cleft palate. Cleft Palate Craniofac J 2018; 55: 437-41
- 8 Abyholm FE, Borchgrevink HC, Eskeland G. Cleft lip and palate in Norway. III. Surgical treatment of CLP patients in Oslo 1954-75. Scand J Plast Reconstr Surg 1981; 15: 15-28
- 9 Maggiulli F, Hay N, Mars M. et al. Early effect of vomerine flap closure of the hard palate at the time of lip repair on the alveolar gap and other maxillary dimensions. Cleft Palate Craniofac J 2014; 51: 43-8
- 10 Millard Jr DR. Rotation-advancement principle in cleft lip closure. Cleft Palate J 1964; 12: 246-52
- 11 Millard DR. Bilateral cleft lip and a primary forked flap: a preliminary report. Plast Reconstr Surg 1967; 39: 59-65
- 12 Millard Jr DR. Refinements in rotation-advancement cleft lip technique. Plast Reconstr Surg 1964; 33: 26-38
- 13 Bardach J. Two-flap palatoplasty: Bardach’s technique. Oper Tech Plast Reconstr Surg 1995; 2: 211-4
- 14 Hay N, Patel B, Haria P. et al. Maxillary growth in cleft lip and palate patients, with and without vomerine flap closure of the hard palate at the time of lip repair: a retrospective analysis of prospectively collected nonrandomized data, with 10-year cephalometric outcomes. Cleft Palate Craniofac J 2018; 55: 1205-10
- 15 Semb G. A study of facial growth in patients with unilateral cleft lip and palate treated by the Oslo CLP Team. Cleft Palate Craniofac J 1991; 28: 1-21
- 16 Bergland O. Changes in cleft palate malocclusion after the introduction of improved surgery. Rep Congr Eur Orthod Soc 1967; 383-97