A Two-Staged Cleft Palate Repair

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.