Current concept of congenital cleft palate repair / Монголын Анагаах Ухаан

Learning objectives: After reading this article, readers should be able to:1. Get information about brief historical aspects of the cleft palate treatment;2. Understand techniques used to repair various types of the cleft palate;3. Understand the optimal timing of the cleft palate repair;4. Understand the results and complications following palate repair including speech, maxillary growth, and fistula formation, regarding with operative techniques and timing of palatoplasty.Summary: Cleft palate is more common congenital anomaly, but surgeons have been eluding surgical correction of the cleft palate for centuries. Many surgical techniques have been described during last two centuries, the goals of these include separating the nasal and oral cavities (avoiding fistulas), establishing normal speech, and preserving maxillofacial growth. This article reviews the brief historical aspects of the cleft palate, palatoplasty techniques, the optimal timing, and the results and complication associated with palate repair technique and timing.

The Two Flap Palatoplasty by Bardach Compared with the Other Methods in Cleft Palate

The purpose of palatoplasty in cleft palate patient is to close the palatal defect completely and create an adequately functioning velopharyngeal mechanism for normal speech production, and to form normal growth of maxilla. Authors tried to analyze postoperative result in two-flap palatoplasty by Bardach' method in terms of operation time, fistula incidence, speech production. The postoperative analysis was done retrospectively in 131 consecutive nonsyndromic patients with cleft palate repaired by a single operator. The patients suffered from complete cleft palate (99 cases) and incomplete cleft palate (32 cases). The complete cleft palate patients were repaired by Wardill-Kilner method (53 cases) and Bardach method (46 cases). All incomplete cleft palate patient were repaired by Furlow method (32 cases). The age of patients who had cleft repair was 8 to 18 months. Mean age was 11.7 months and mean follow- up period was 21 months. Mean operation time was similar in patients with Wardill-Kilner method, Furlow method, Bardach method. The fistula rate of Bardach method was lower than other methods. Hypernasality test and articulation test were done by speech evaluation table which was consisted of 29 different words. We ascertained the truth of adequate speech production in patients with Bardach method as a results of our study. The 2 flap palatoplasty by Bardach method is not a difficult method compared with other methods. And it can be suggested to close the cleft palate with minimal or no exposure of palatal bone and reduce the fistula incidence. In addition, it can provide adequate production of speech in cleft palate patients.

Repair of Complete Cleft Palate by Modified 2-Flap Palatoplasty

The goal of palatoplasty is focused on two points. One is to close the palatal defect completely and the other is to create velopharyngeal system for normal speech production. After palatoplasty, scaring of palatal bare area is an important factor contributing to maxillofacial growth aberration. Bardach reported that most palatal clefts could be closed without bare bone by using the two-flap palatoplasty. On the basis of clinical experiences of the two-flap palatoplasty, authors made the lateral incision on the noncleft side to decrease the chance of bony exposure. From November 2000 to January 2001, nine children with complete cleft palate underwent two-flap palatoplasty without lateral incision on noncleft side (modified two-flap palatoplasty). Mean age at cleft repair was 11.2 months, and mean follow-up period was 2.9 months. Incision was performed on the medial edges of both side and the alveolar ridge of the cleft side. After elevation, the mucoperiosteal flaps of both sides were rotated downward. The palatal gap was simply closed without tension. Palatal fistula did not occur, and there was no postoperative bleeding. Modified two-flap palatoplasty method can be suggested to reduce the bare bone exposure, scarring and resultant growth disturbance. However, more in-depth study by long term follow-up is needed to evaluate growth pattern and speech evaluation.