Result study after two stages repair of cleft palate In infancy

An early closure of the soft palate was advocated in the management of ten cleft palate patients and it was found that the early closure of the soft palate in this series has the advantage of early function and growth that occurred in the soft palate which is vital in the development of speech, furthermore it avoids the pitfall of maxillofacial growth disturbances related to early periosteal undermining of the palate. Whereas the closure of the cleft in the hard palate is postponed with the intention of minimizing interference with maxillary growth. Also it was found that most of that clefts narrows spontaneously after velar closure as a result of further growth of the palate. The best cases that get benefit from this trend were found to be the cases of wide palatal clefts whether bilateral complete clefts or isolated types and cases associated with cleft alveolus. Early closure of the soft palate in cases of complete cleft palate is beneficial in establishing both the continuity and the function of the muscles of the soft palate. Also the residual cleft in the palate that narrows by time can be closed later on with minimal dissection of the palatal mucoperiosteum. So we conclude that, early closure of the soft palate should be performed alone without repair of the cleft in the hard palate in all cases of bilateral and unilateral complete cleft lip and palate either separately or simultaneously with the lip repair and in cases of isolated cleft palate especially in cases with wide palatal cleft. Also, the soft palate can only be closed in older patients with very wide complete cleft palate in which it can not be closed in one stage

U vular double opposing z- plasty: a new method of cleft palate repair

In this prospective study, a new technique in the repair of cleft palate utilizing the uvular tissue to lengthen the palate was done. This technique was done not only to achieve the anatomical repair of the palate, but also to determine the improvement of speech outcome as measured objectively by a speech pathologist. In the uvular transposition procedure, the palate was lengthened with tissue from the uvular by a double-opposing Z-plasty, an intravelar veloplasty was performed and most of the uvular mass, about 2/3, was transposed to the nasal surface of the soft palate. The study was carried out at the Pediatric Surgery Unit, Faculty of Medicine, Al-Azhar University from January 1999 to December 2002 to evaluate the speech outcome by using the uvular double opposing Z-plasty in the repair of cleft palate. Forty children, aging from 1-2 years old, with a complete cleft palate were treated by this procedure. Then, the children were enrolled for follow up programming and blindly evaluated every six months. Perceptual nasal emission was found to be normal in 38 of the 40 children. Nasometry was performed in all 40 children. Only one child of these patients required pharyngeal flap for velopharyngeal dysfunction. Also, one child was improved by training at the Phonetic Unit by a specialist, where no more surgery was done