Palatoplasty is the surgical procedure used to correct cleft lip and cleft palate. The former refers to the abnormal gap that develops between the mouth and the nose while the latter is the split or gap in the roof of the mouth. Laser-assisted palatoplasty or uvuloplasty (LAP or LAUP) was introduced as a treatment for snoring. Palatoplasty, also referred to as cleft palate reconstruction surgery, was developed to help affected infants breath, swallow, and speak as normally as possible.
There are several techniques considered in performing this procedure.
Who candidate for Palatoplasty
Parents of infants with cleft lip and cleft palate should consult a specialist at the earliest time possible. Since infant tissues are quite delicate, palatoplasty is usually delayed until the baby is around six months to a year old. This is considered the optimal time since babies heal faster around this time. Performing cleft palate reconstruction surgery at this early age would also help prevent speech problems later on. Studies have also shown lesser facial deformity when the procedure is performed before the child’s first birthday.
Older children and adults are also eligible to undergo palatoplasty, though they run the risk of suffering from social stigma because of their appearance and speech impairment due to their condition.
The majority accept 6 to 12 months as the optimum age for palatoplasty. There are many centres performing palatoplasty between 12-18 months. There are a few who perform at least a part of the palatoplasty as late as 10-12 years.
Ideally, one should consider the development of babbling as an indicator of the time to reconstruct the palate. it is preferable to use peri-operative antibiotics.
A palatoplasty is a surgical procedure performed either in the office or in the operating room and is designed to treat snoring and obstructive sleep apnea.
The goals of palatoplasty are, of course, in addition to closing the oral and nasal communication, to promote an intelligible speech, as close as possible to the normal range, and prevent interference with the maxillary growth (which, in the future, would entail the need for orthopedic maxillary expansion and subsequent orthognathic surgery).
In-office palatoplasty is a 10 minute procedure performed under local anesthesia and the Surgical palatoplasty is performed in the operating room and is used as part of airway treatment for obstructive sleep apnea.
The soft palate and uvula are reconstructed in a manner that decreases retropalatal obstruction, a common source of airway obstruction during obstructive sleep apnea. There are many different ways to perform this procedure (Lateral pharyngoplasty, sphincter expansion pharyngoplasty, uvulopalatopharyngoplasty), and the specific approach is determined by your anatomy.
The procedure takes about 35 minutes to perform and is associated with a sore throat for about 7-10 days.
There are several palatoplasty techniques described in the literature, the choice based on several criteria: type of fissure, fissure extension, preference and technical skill of the surgeon.
most relevant and useful techniques includes:
- von Langenbeck’s bipedicle flap technique
- Veau-Wardill-Kilner Pushback technique
- Bardach’s two-flap technique
- Furlow Double opposing Z-Plasty
- Two-stage palatal repair
- Hole in one repair
- Raw area free palatoplasty
- Alveolar extension palatoplasty (AEP)
- Primary pharyngeal flap
- Intravelar veloplasty
- Vomer flap
- Buccal myomucosal flap
Principles of Palatoplasty
- Closure of the defect.
- Correction of the abnormal position of the muscles of the soft palate, especially Levator Palati.
- Reconstruction of the muscle sling.
- Retropositioning of the soft palate so much so that during speech the posterior part of the soft palate comes in contact with the posterior pharyngeal wall during speech.
- Minimal or no raw area should be left on the nasal side or the oral surface.
- Tension-free suturing.
- Two-layer closure in the hard palate region and a three-layer closure of the soft palate.
recovery and post-op
The use of the nonsteroidal anti-inflammatory drug, diclofenac, in the form of rectal suppository provides effective analgesia. Injectable fentanyl with a basal infusion rate of 0.63 microgram/kg/h is effective in postoperative pain management in children undergoing cleft palate repair.
Arm restraints are used to avoid self-inflicted trauma with uncontrolled hand movement of the child during postoperative period
Dehiscence of the repair
Oronasal fistula formation
· Late complications
Dental malpositioning and malalignment