Different surgical flapes are used for closure of cleft palate. Different factors affecting technique success. In terms of simplicity of the procedure and fistula rate following hard palate closure.
What is the best flap
Factors affecting your choice
Main goals for this technique
I appreciate your time and support
Thank you
There are many techniques for hard palate repair that include both surgical issues and timing. In the US, nearly everyone repairs the hard palate before speech onset, ranging from about 8 months to 1 year of age. Because hard palate clefts (congenital) always occur with soft palate clefts, most people repair the entire palate at the same time, although some places do a 2 stage repair. Some centers, although this is not common, repair the hard palate at the same time as a cleft of the lip, if it is present, at about three months followed by soft palate repair at 1 year or before. For the most part, however, in the US, hard and soft palate repair are done together between 9 and 12 months. There are, however, many variations on this schedule. In terms of technique, the Furlow palatoplasty is very popular at this time (double reversing Z-plasty). The hard palate can be repaired using vomer flaps or palatal flaps, as in the two flap technique of Bardach. The choice of technique usually depends on the availability of local soft tissue. There are literally hundreds of publications in the journal literature and many, many text books.
Dear Dr Robert Shiprintezen,
Than you for your valuable reply.
But in terms of less complications, what is the surgical techniue with less complications depending on meta analysis.
I think this issue should be studied depending on systematic reviews of the avalible evidence. But this will be a challenge due to multiple factors. What's your opinion?
My opinion is that complications (I presume you are talking about fistulae) are more surgeon dependent than surgery dependent. I am sure you can appreciate that there is more variation in results between two surgeons doing the same procedure than one surgeon doing two procedures. In other words, a good surgeon knows how to solve problems and avoid complications no matter what he or she is doing. Do you agree?
Yes of course, surgeon skills play a vital role in reduction of complications particularly fistulas. My hope to summarize the whole evidence about this issue. But I wish experts put their guidance and I welcome who wants to share this project with.
My own personal experience has been that the procedures with the outcomes in terms of fistulae are obviously those with the least tension. From 1974 through 1997 I was the Director of a very large craniofacial center in New York City. We saw approximately 400 to 500 new cases per year. Our surgeons used vomer flaps for the anterior palate repair and a V-Y lengthening of the soft palate. The fistula rate was very low...approximately 2%. We had 4 surgeons doing the cases and one of them had essentially no fistulae in the 24 years I worked with him, while the surgeon with the largest number of fistulae had approximately 5%, Obviously, there were many variables, including the severity of the clefts, the age at repair, and the status of the soft tissue, My experience with surgeons from elsewhere was that the ones who delayed hard palate repair, doing the soft palate first at 6 months and then the hard palate at 18 months, had a very high rate of fistulae...well over 10% and some even worse. I hope that is helpful. Good luck with your research.
Thank you for your valuable comments. I appreciate your time and sharing experience with others.
my own personal experiences for almost 75 patients most of them perform the surgery in 10-12 months old 80% and the rest are adults. 100% use the 1 step veau wardill kilner palatoplasty from 2010 until now and the results were good, only 3% of all the patients with post op bleeding complication and 15% with fistulae due to tension because of a large cleft and bad oral higienes... I hope this will help you in your research, good luck