Postoperative evaluation of palatoplasty using the modified Kaplan method

Area of Science:

• Craniofacial surgery
• Pediatric plastic surgery
• Cleft lip and palate research

Background:

• Cleft palate repair presents challenges in achieving optimal velopharyngeal function and preventing midface hypoplasia.
• The modified Kaplan method utilizes bilateral buccal mucosal flaps for nasal mucosal pushback.
• Understanding the long-term effects of this technique on craniofacial morphology and speech is crucial.

Purpose of the Study:

• To evaluate the efficacy of the modified Kaplan method in primary palatoplasty.
• To assess velopharyngeal function, articulation, and craniofacial morphology in children undergoing this procedure.
• To determine if bilateral buccal mucosal flaps prevent maxillary and mandibular length contraction.

Main Methods:

• Retrospective study of 44 children with cleft palates who underwent primary palatoplasty using the modified Kaplan method.
• Bilateral buccal mucosal flaps were transposed to the nasal mucosal raw surface at the hard and soft palate junction.
• Evaluation included assessment of velopharyngeal function, articulation, and craniofacial morphology (SNA, SNB angles, maxillary dimensions).

Main Results:

• Good velopharyngeal function was observed in 72.7% of subjects.
• Articulation disorders were present in 59.1% of patients.
• Craniofacial analysis showed no significant changes in SNA and SNB angles, with no marked loss of maxillary-mandibular balance or significant differences in maxillary length and width.

Conclusions:

• The modified Kaplan method with bilateral buccal mucosal flaps is effective for nasal mucosal pushback in cleft palate repair.
• This technique appears to prevent contraction of maxillary and mandibular lengths, contributing to stable craniofacial morphology.
• Further research may explore long-term speech outcomes and refine surgical techniques for cleft palate management.