Cleft palate repair using a marginal musculo-mucosal flap

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Surgery

Background:

• Cleft palate repair aims to restore function and aesthetics.
• Minimizing complications like fistulas and growth disturbances is crucial.
• Existing techniques have limitations in soft palate lengthening and fistula prevention.

Purpose of the Study:

• To describe a modified palatoplasty using a mucoso-periosteal flap and a marginal musculo-mucosal (3M) flap.
• To evaluate the effectiveness of the 3M flap in primary complete cleft palate repair.
• To assess the impact on nasal mucosal layer lengthening and fistula formation rates.

Main Methods:

• A mucoso-periosteal flap from the hard palate was used for cleft closure.
• A marginal musculo-mucosal (3M) flap was employed to repair nasal mucosal defects and lengthen the soft palate.
• Intravelar veloplasty was performed concurrently in 48 patients (21 unilateral complete clefts, 27 incomplete clefts).

Main Results:

• The 3M flap successfully repaired nasal mucosal defects ranging from 10-12 mm in length and 15-20 mm in width.
• Oronasal fistula formation occurred in only 3 out of 48 patients (6.25%), located at the hard-soft palate junction.
• The technique allowed for significant lengthening of the nasal mucous layer of the soft palate.

Conclusions:

• The 3M flap technique effectively addresses tissue deficiency, potentially preventing fistula formation.
• This method facilitates soft palate elongation and muscular retropulsion, aiming for improved velopharyngeal function.
• The non-push-back approach to hard palate repair may minimize maxillary growth retardation.