1. Modifying the Two-Stage Cleft Palate Surgical Correction
- Author
-
Errol Noik, Laurence A. Chait, Cathy Graham, Gerald Gavron, and Gavin De Aguiar
- Subjects
Male ,Palate, Hard ,medicine.medical_specialty ,ORTHODONTIC PROCEDURES ,Speech-Language Pathology ,Time Factors ,Decision Making ,Orthodontics ,Malocclusion, Angle Class II ,Speech Disorders ,Surgical Flaps ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Periosteum ,Palatal Muscles ,medicine ,Humans ,030212 general & internal medicine ,Stage (cooking) ,Patient Care Team ,Soft palate ,business.industry ,Infant ,030206 dentistry ,Surgical correction ,medicine.disease ,Surgery, Oral ,Surgery ,Cleft Palate ,Otitis Media ,Malocclusion, Angle Class III ,Treatment Outcome ,medicine.anatomical_structure ,Otorhinolaryngology ,Child, Preschool ,Female ,Mucoperiosteum ,Hard palate ,Palate, Soft ,Oral Surgery ,Malocclusion ,business ,Oral Fistula - Abstract
Objective This paper reports the experience with a two-stage approach to surgical correction of the complete cleft palate, wherein timing of the second stage is dependent on the judgment of the speech pathologist and the orthodontist together with the surgeon. Patients Of a total of 35 patients having complete unilateral clefts a sample of 22 were available for postsurgical assessment. The first-stage repair of the palate was carried out at an average age of 10.7 months (range 6 to 17 months), and the second-stage repair of the residual cleft was completed at an average age of 32.7 months (range 26 to 34 months). Interventions The first-stage repair of the soft palate defect involved mobilizing two short posteriorly based flaps, which extend onto the posterior quarter of the hard palate thus including up to 1 cm of mucoperiosteum. Careful freeing of the muscle is followed by an intravelar veloplasty. The later closure of the residual cleft involved turnover hinge flaps and small mucoperiosteal flaps. Results Eighty-seven percent of the sample had good to excellent speech as assessed by the Great Ormond Street screening method. Only two patients showed evidence of recessive maxillae with Class III malocclusions. Conclusions A two-stage surgical closure of the palate using this procedure would appear to confer several valuable advantages to the patient. These include favorable outcomes for speech in the large majority of cases and minimal adverse effects on the growth of the midface region.
- Published
- 2002