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Evaluation of maxillary growth: is there any difference using relief incision during palatoplasty?
Ivan Maluf1, Ubiratan Doro, Taíse Fuchs
1From the *Plastic Surgery Service, Hospital de Clínicas da Universidade Federal do Paraná; †Universidade de São Paulo, Integrated Center for Cleft Palate (CAIF); ‡Veterinary Medicine, Evangelical University of Paraná; §Evangelical University of Paraná, and ∥Plastic Surgery, University Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
Introduction:
Scar retraction due to exposed bone in palatoplasty is the leading cause of constricted maxilla. Modern techniques have focused on minimizing the effects of scarring by reducing the exposure of the bone area.
Objective:
The objective of the study was to compare the palatal mucoperiosteal detachment with minimal lateral incision, followed by their synthesis, with the maintenance of lateral areas for relaxation (similar to the von Langenbeck technique) and evaluate the transversal development of the maxilla.
Methods:
A prospective, randomized study was conducted, in which the molding of the dental arch of 14 pigs in 2 stages (at 1 month and 5 months) was performed. The pigs were divided into 3 groups: group 1 underwent lateral incision of the palate for mucoperiosteal detachment and maintenance of bone exposure; group 2 underwent mucoperiosteal palatal detachment with lateral access and no bone exposure; and group 3, the control animals, did not undergo any surgical procedures. Measurements of the dental arches were compared between the groups to assess differences in the development of the maxillary transverse diameter.
Results:
There were no animals lost during the study. Group 1 showed greater growth restriction of the transverse diameter of the maxilla (36%) when compared with groups 2 (56%) and 3 (59%). Groups 2 and 3 showed similar transverse maxillary development, with no statistical difference.
Conclusions:
The technique of mucoperiosteal detachment without lateral relief incision has the advantage of reducing future morbidity of a constricted maxilla. This study demonstrated that the technique described can reduce rates of maxillary underdevelopment, a significant complication inherent in the procedure for palatoplasty. The lateral incisions reduce maxillary growth by approximately 20% as compared with this technique. Level II of evidence.
