The Clinical Research Of The Palatal Mucosal Flap Applied To Repair Soft Palate Cleft

Objective Palate surgery at an early age may result in retardation of maxillary growth. Palatoplasty is considered to be the major cause of the growth retardation. This study aims to explore a new method to repair soft palate cleft. Methods 20 patients with soft palate cleft aged from 18 months to 22 years were selected to be repaired with the palatal mucosal pushback flap, who had been diagnosed to exclude systemic disease, acoustic and intellectual deformity. With general anesthesia via tracheal intubation, palatal surgery was performed by using a palatal mucosal pushback flap. On the palatine process, we used a partially splitted flap technique in the mucoperiosteum of the palate. The palatal mucosal flap was elevated while the periosteum was left in situ without damage. The greater palatine neurovascular bundle remained intact. Without breaking the pterygoid hamulus, we detached and freed the levator muscle. The levator veli palatine muscle sling was reconstructed anatomically. The nasal mucosa of soft palate was elongated with a Z-plasty. After posterior movement, the oral flap was sutured to the posterior nasal mucosa. Results Operations were successfully completed on all patients. Wound healing of soft palate and uvular was uneventful with no incidence of infection, necrosis or dehiscence. Among them, 13 patients were monitored postoperatively after 3 months. Permanent fistula between the oral cavity and the nasal cavity occurred in 2 patients. Others obtained good healings on their palates. This technique of supraperiosteal flap produced minimal scars in palate with better velopharyngeal function which was confirmed by fogged mirror, nasopharyngeal fibroendoscope and lateral cephalometric radiograph with barium. Conclusion The method is ideal to repair soft palate cleft. It is safe, practical with good clinical results. It can recover the velopharyngeal function. Furthermore it can avoid bone denudation, scar contraction, blood destruction. It is beneficial to minimize the bad influences towards the development and growth for maxilla of cleft soft palate patients.