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A Two-Staged Cleft Palate Repair

  • Nasser Nadjmi
Chapter

Abstract

The goals for treatment of the cleft palate patient are normal speech, normal maxillofacial growth, normal auditory tube function, and avoiding fistulas. The timing of hard palate closure has been the subject of controversy in the literature. The debate concerning one-stage cleft repair versus two-stage palatoplasty has traditionally been an argument about the relative value of speech development versus acceptable maxillofacial growth.

In this chapter a two-stage palatal repair using a modification of FP is presented. The author emphasizes that these modifications significantly improve speech results. Furlow’s technique has been modified in two ways. The first modification, which the author uses in all palatal repairs, is reuniting the levator muscles with a minimal overlap, instead of complete overlap of the myomucosal flaps. The second modification is using a buccinator myomuccosal flap to achieve a tension-free oral layer closure and avoid exposition of raw surfaces in wider palatal clefts. In this way the necessity to make relaxing incisions and back cuts at the base of the anteriorly based oral layer, in order to close the palatal layer in wide palatal clefts, is omitted.

References

  1. 1.
    Spauwen PH, Goorhuis-Brouwer SM, Schutte HK. Cleft palate repair: Furlow versus von Langenbeck. J Craniomaxillofac Surg. 1992;20:18–20.CrossRefPubMedGoogle Scholar
  2. 2.
    Rohrich RJ, Love EJ, Byrd HS, Johns DF. Optimal timing of cleft palate closure. Plast Reconstr Surg. 2000;106:413–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Emory RE Jr, Clay RP, Bite U, Jackson IT. Fistula formation and repair after palatal closure: an institutional perspective. Plast Reconstr Surg. 1997;99:1535–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Losee JE, Smith DM, Afifi AM, Jiang S, Ford M, Vecchione L, et al. A successful algorithm for limiting postoperative fistulae following palatal procedures in the patient with orofacial clefting. Plast Reconstr Surg. 2008;122:544–54.CrossRefPubMedGoogle Scholar
  5. 5.
    Furlow LT. Cleft palate repair by double opposing Z-plasty. Plast Reconstr Surg. 1986;78:724–38.CrossRefPubMedGoogle Scholar
  6. 6.
    Guneren E, Uysal AO. The quantitative evaluation of palatal elongation after Furlow palatoplasty. J Oral Maxillofac Surg. 2004;62:446–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Gunther E, Wisser JR, Cohen MA, Brown AS. Palatoplasty: Furlow’s double reversing Z-plasty versus intravelar veloplasty. Cleft Palate Craniofac J. 1998;35:546–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Brothers DB, Dalston RW, Peterson HD, Lawrence WT. Comparison of the Furlow double-opposing Z-palatoplasty with the Wardill–Kilner procedure for isolated clefts of the soft palate. Plast Reconstr Surg. 1995;95:969–77.CrossRefPubMedGoogle Scholar
  9. 9.
    Randall P, LaRossa D, Solomon M, Cohen M. Experience with the Furlow double-reversing Z-plasty for cleft palate repair. Plast Reconstr Surg. 1986;77:569–76.PubMedGoogle Scholar
  10. 10.
    Chen PK, Wu JT, Chen YR, Noordhoff MS. Correction of secondary velopharyngeal insufficiency in cleft palate patients with the Furlow palatoplasty. Plast Reconstr Surg. 1994;94:933–41.CrossRefPubMedGoogle Scholar
  11. 11.
    Chen PK, Wu J, Hung KF, Chen YR, Noordhoff MS. Surgical correction of submucous cleft palate with Furlow palatoplasty. Plast Reconstr Surg. 1996;97:1136–46. discussion 1147–1149.CrossRefPubMedGoogle Scholar
  12. 12.
    Lindsey WH, Davis PT. Correction of velopharyngeal insufficiency with Furlow palatoplasty. Arch Otolaryngol Head Neck Surg. 1996;122:881–4.CrossRefPubMedGoogle Scholar
  13. 13.
    LaRossa D, Jackson OH, Kirschner RE, Low DW, Solot CB, Cohen MA, et al. The children’s hospital in Philadelphia modification of the Furlow double-opposing Z-palatoplasty: long-term speech and growth results. Clin Plast Surg. 2004;31:243–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Mann RJ, Fisher D. Bilateral buccal flaps with double opposing Z-plasty for wider palatal cleft. Plast Reconstr Surg. 1997;100:1139–43.CrossRefPubMedGoogle Scholar
  15. 15.
    Nakakita N, Maeda K, Ojimi H, Utsugi R, Maekawa J. The modified buccal musculomucosal flap method for cleft palate surgery. Plast Reconstr Surg. 1991;88:421–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Horswell BB, Castiglione CL, Poole AE, Assael LA. The double-reversing Z-plasty in primary palatoplasty: operative experience and early results. J Oral Maxillofac Surg. 1993;51:145–9. discussion 149–150.CrossRefPubMedGoogle Scholar
  17. 17.
    Kitagawa T, Kohara H, Sohmura T, Takahashi J, Tachimura T, Wada T, et al. Dentoalveolar growth of patients with complete unilateral cleft lip and palate by early two-stage Furlow and push-back method: preliminary results. Cleft Palate Craniofac J. 2004;41:519–25.CrossRefPubMedGoogle Scholar
  18. 18.
    Furlow LT. Flaps for cleft lip and palate surgery. Clin Plast Surg. 1990;17:633–44.PubMedGoogle Scholar
  19. 19.
    Furlow LT. Cleft palate repair by double opposing Z-plasty. Oper Tech Plast Reconstr Surg. 1995;2:223.CrossRefGoogle Scholar
  20. 20.
    Chen GF, Zhong L. A bilateral musculomucosal buccal flap method for cleft palate surgery. J Oral Maxillofac Surg. 2003;61:1399–404.CrossRefPubMedGoogle Scholar
  21. 21.
    Nadjmi N, Van Erum R, De Bodt M, Bronkhorst EM. Two-stage palatoplasty using a modified Furlow procedure. Int J Oral Maxillofac Surg. 2013;42:551–8.CrossRefGoogle Scholar
  22. 22.
    Lacameli GR, Dolan R. Buccinator musculomucosal flap: applications in intraoral reconstruction. Arch Otolaryngol Head Neck Surg. 1998;124:69–72.CrossRefGoogle Scholar
  23. 23.
    Maeda K, Ojimi H, Utsugi R, Ando S. A T-shaped musculomucosal buccal flap method for cleft palate surgery. Plast Reconstr Surg. 1987;79:888–96.CrossRefPubMedGoogle Scholar
  24. 24.
    Bozola AR, Gasques JA, Carriquiry CE, Cardoso de Oliveira M. The buccinators musculomucosal flap: anatomic study and clinical application. Plast Reconstr Surg. 1989;84:250–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Jackson IT, Moreira-Gonzalez AA, Rogers A, Beal BJ. The buccal flap a useful in cleft palate repair? Cleft Palate Craniofac J. 2004;41:144–51.CrossRefPubMedGoogle Scholar
  26. 26.
    Smith DM, Vecchione L, Jiang S, Ford M, Deleyiannis FW, Haralam MA, et al. The Pittsburgh fistula classification system: a standardized scheme for the description of palatal fistulas. Cleft Palate Craniofac J. 2007;44:590–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nasser Nadjmi
    • 1
  1. 1.Department of Cranio-Maxillofacial SurgeryUniversity of Antwerp, University Hospital Antwerp, ZMACK AssociationAntwerpBelgium

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