Comparison of Two-Flap Palatoplasty and Pushback Palatoplasty: Complication Rates

ABSTRACT

The objectives of palatoplasty are to close the palatal defect completely and create and adequately functioning velopharyngeal mechanism for normal speech production. The goal is to minimize adverse effects on maxillofacial growth. The are various surgical techniques in cleft palate repair procedure. According to the report of Bardach and Salyer, two-flap palatoplasty allows closure of the palatal cleft with minimal or no exposure of the bare bone by downward rotation of the mucoperiosteal flap instead of posterior transposition. Thus, two-flap palatoplasty is totally different from the concepts and techniques of other palatoplasties and it results in minimal or no adverse effects on maxillofacial growth. But, there have been no reports about two-flap palatoplasty in Korea. We retrospectively reviewed postoperative complications of 172 consecutive nonsyndromic patients with cleft palate repaired by single operator(two-flap palatoplasty 120 cases, pushback palatoplasty 52 cases). Submucous cleft palate patients were excluded from the study group. Age at cleft repair was from 3 months to 51 years and mean follow-up period was 29 months. Cleft palate fistulas occurred in 20 of 172 patients(11.6%), and fistula rate was similar in patients with two-flap palatoplasty (10.8%) and in patients with pushback palatoplasty (13.5%). Type of palatoplasty, extent of clefting, and age at palate repair did not significantly affect the fistula formation. Of the 52 cleft palates repaired with pushback palatoplasty, there has been one postoperative bleeding that resulted in reoperation. But, of the 120 cleft palates repaired with two-flap palatoplasty, there has been no incidence of postoperative bleeding. Two-flap palatoplasty is considered to be another choice of operative method of palatoplasty. However, more in-depth study is needed to clarify the relationship between two-flap palatoplasty and speech pattern, maxillofacial growth.