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Comparative Outcomes of Conventional Bardach Two-Flap Palatoplasty Versus Modified Alveolar Ridge/Crevicular Incision
Saikrishna Degala1, Amey Hariani1
1Department of Oral and Maxillofacial Surgery, Jagadguru Sri Shivarathreeshwara (JSS) Dental College and Hospital, Mysuru, IND.
Cureus
|December 23, 2025
Summary
A modified two-flap palatoplasty technique for isolated cleft palate (CP) showed similar surgical and functional outcomes to the conventional method. The modified approach may offer better tissue mobilization and tension-free closure, especially in wider clefts, without increasing complications.
Area of Science:
- Craniofacial Surgery
- Pediatric Surgery
- Plastic Surgery
Background:
- Isolated cleft palate (CP) significantly impacts a child's feeding, speech, and social development.
- Conventional Bardach two-flap palatoplasty can result in exposed bone, potentially hindering jaw growth.
- A modified technique utilizes alveolar ridge or gum crevice incisions to improve tissue mobilization and minimize bone exposure.
Purpose of the Study:
- To compare the operative efficiency, postoperative complications, and functional outcomes of conventional versus modified two-flap palatoplasty techniques.
- To evaluate the efficacy of the modified technique in achieving tension-free closure and minimizing exposed bone in pediatric CP repair.
Main Methods:
- A prospective, observational study involving 24 children (12-24 months) with Veau I/II isolated CP.
- Two groups were formed: Group A (conventional Bardach) and Group B (modified technique with alveolar/crevicular incisions).
- Outcomes assessed included operative time, closure tension, fistula formation, nasal regurgitation, uvular morphology, and tooth eruption over 18 months.
Main Results:
- Operative times were comparable (135 min conventional vs. 141.67 min modified; p=0.387).
- Tension-free closure was achieved in 66.67% of conventional cases versus 100% of modified cases (p=0.121).
- No significant differences were observed in fistula formation, nasal regurgitation, or tooth eruption delays; uvular morphology was slightly better in the modified group.
Conclusions:
- Both conventional and modified two-flap palatoplasty techniques demonstrate equivalent surgical and functional results with minimal morbidity for Veau I/II isolated CP.
- The modified technique shows a trend towards improved tissue mobilization and tension-free closure in wider clefts without increased operative time or complications.
- Further randomized trials are recommended to validate these findings with long-term cephalometric and speech assessments.
