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Cleft Palate Repair Using Single Flap Palatoplasty in Patient With Associated Palatal Hemangioma
Murat Kara1, Mert Calis1, Canan Akyuz2
1Department of Plastic Reconstructive and Aesthetic Surgery.
Insights
This study details a rare case of infantile hemangioma coexisting with cleft palate. Early intervention with propranolol and timely surgical repair led to successful outcomes.
Area of Science:
- Pediatric Surgery
- Oral and Maxillofacial Surgery
- Vascular Anomalies
Background:
- Infantile hemangiomas are common pediatric tumors, but palatal hemangiomas are rare.
- Cleft palate affects speech development, necessitating timely surgical intervention.
- The coexistence of palatal hemangioma and cleft palate presents unique surgical challenges.
Observation:
- A 4-month-old infant presented with Veau 2 cleft palate and a large hemangioma on the hard palate.
- MRI confirmed a 2.2x1.3 cm vascular lesion on the right hard palate.
- The patient received 7 mg/day oral propranolol to reduce hemangioma size.
Findings:
- Propranolol treatment effectively reduced the hemangioma size, allowing for subsequent cleft palate repair.
- The cleft palate was surgically repaired at 11 months using a modified technique to accommodate the hemangioma.
- No intraoperative or postoperative complications were observed during early and late follow-up.
Implications:
- This case highlights the successful management of a rare combined condition.
- Early surgical repair of cleft palate is crucial for optimal speech outcomes, even with coexisting hemangiomas.
- A multidisciplinary approach involving propranolol therapy and tailored surgical techniques is effective.
Abstract:
Hemangiomas are the most common tumors of childhood with an average incidence of 10%. It is unusual for hemangiomas, which are already rarely seen isolated on the palate, to coexist with cleft palate as in the authors' patient. Four months old baby was admitted with isolated Veau 2 cleft palate and a red-purple colored raised lesion involving almost the whole right side of the hard palate. Magnetic resonance imaging revealed intensive contrasting solid nodule with a lobulated contour that was covering the right half of the hard palate, measuring 2.2×1.3 cm. To reduce the size of the vascular lesion 7 mg/d oral propranolol treatment was initiated. Following reduction in the size of hemangioma, the cleft palate was repaired at 11 months of age. Single mucoperiosteal flap from the left side of the palate preserving the major palatine artery was elevated whereas right mucoperisteal flap was minimally dissected not to interfere with the hemangioma. No intraoperative and postoperative complications in both the early and late term were experienced. As a result, since early palatal repair is important to obtain ideal speech outcomes in cleft patients, repair should be performed in similar patients with hemangiomas without delaying the timing.
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