Island soft palatoplasty for early reconstruction of the posterior muscular ring

Restoration of the continuity of the posterior muscular ring and production of adequate palatal length have been the prime objectives cleft surgeons have sought in their drive to obtain good speech. Twelve patients with cleft palates varying from incomplete clefts of the secondary palate to wide clefts associated with unilateral and bilateral lip deformities have been repaired utilizing an early radical soft palate release from the hard palate. The element not stressed in prior early soft palatoplasties is this full-thickness release of the soft palate from its abnormal insertion along the cleft. This allows the reconstructed soft palate to function independently as part of the posterior muscular ring. This approach also partly corrects the orientation of the levator muscles and avoids internal scarring in the soft palate caused by extensive dissection. The series of cases reported here is small, and although the results are very encouraging, this approach cannot be claimed as a panacea for all the problems of soft and hard palate repair. The sound fundamental principle of reconstructing the functional unit without regard to filling the hole is the essence of this approach. Hard palate closure is delayed until the functional unit (the soft palate) is well-established as part of the posterior muscular ring. To do this requires a radical separation of the hard and soft palate clefts both surgically and conceptually. The benefits indicated in this series seem to follow directly from these principles. The cases repaired by the island soft palatoplasty have long, mobile soft palates with the correct orientation and relationship of muscles. They have developed good palatal motion, velopharyngeal competence, and good speech.