Correction of Congenital Palate Defects
Surgical Techniques to Repair Cleft Palates
- Small / Narrow Cleft - If the cleft opening is small and there is an abundance of soft tissue on either side, after debridement of the epithelium at the edges of the defect, the mucoperiosteum is advanced over the lesion and sutured with either a simple interrupted 5-0 monocryl suture pattern or using interrupted horizontal mattress sutures if there is more tension along the closure site.
- Wide Cleft - In cases of a wide cleft in the palatal midline, full thickness releasing incisions are made parallel to the dental arches on both side. The mucoperiosteum is elevated off the underlying bone along with the palatine arteries and advanced over the cleft and sutured with single interrupted alternating simple and horizontal mattress 5-0 Monocryl sutures.
- Caudal Soft Palate - When the cleft involves the caudal soft palate, the two sides are debrided and advanced over the midline defect. The closure is made in two layers: the deeper muscle layer is first closed and the superficial mucosal layer is subsequently apposed and closed.
Surgical Correction of Clefts
Surgical correction of congenital palate defects such as clefts can be divided into two areas: Primary and Secondary clefts. These are dependent on their localization or position either towards the front of the mouth or more towards the back. In either case, the affected maxillary bone which is the basis of the roof of the mouth has not fused typically along the midline of the face during the embryological development of the skull.
In primary clefts, the premaxillary or incisal bone is affected. This often causes the characteristic hairlip which is a split in the lip structure secondary to a lack of fusion of the two halves of the face. Not only is the soft tissue affected but in addition the underlying bone support is lacking. The reconstructive surgery of these defects involve plastic skin and oral mucosal flap procedures to close these lesions
Secondary clefts occur behind the incisal papilla ( the normal swelling on the roof of the mouth) towards the front and can extend through and including the soft palate towards the back of the mouth. In their repair it is often necessary to elevate and move the soft tissue over the hard palate. This can occur on both sides of the cleft moving these flaps towards the midline and then subsequently suturing them together.
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