Release of the Lateral Pharyngeal Mucosa Using a Palatal Elevator

The aim of this paper is to present how to release the nasal mucosa from the hard palate and from the lateral pharyngeal wall using palatal elevator.After mucoperiosteal flap is raised, the nasal mucosa is detached with an instrument pushed laterally behind the palatine vessels to meet the medial pterygoid plate. The palatal elevator is passed around the spine at the posterior medial border of the bony palate and then moved forward in the cleft to separate the nasal mucosa from bone. The palatal elevator is now introduced behind the greater palatine vessels, maintaining contact with the medial pterygoid plate. The elevator is pushed deeply up toward the base of the skull to elevate the lateral pharyngeal mucosa medially. When this mucosa is freed, the elevator can be moved anteriorly to separate the nasal mucosa from nasal side wall and upper surface of the hard palate. After closure of the buccal layer, 2 posterior flaps are joined to the small anterior flap. Finally, an A suture is made to hold the buccal layers together with the nasal mucosa and lateral pharyngeal mucosa to obliterate dead space.Herein, the authors present how to completely free the nasal mucosa from the hard palate and from the lateral pharyngeal wall before medial shifting and suturing. In our series of 60 cases of complete or incomplete cleft palate, fistula rate was low (6.7%), which the authors suggest was due to the low tension of the sutured nasal lining with the released lateral pharyngeal wall.