eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Cleft Palate Repair: Multimedia

Author: Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Coauthor(s): Raja Ramaswamy, MS, The Chicago Medical School; Mitchell F Grasseschi, MD, Assistant Professor, Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University; Private Practice, Plastic and Reconstructive Surgery; Mary M O'Gara, MA, CCC-SLP, Associate Professor, Department of Plastic Surgery, Northwestern University Medical School; Speech/Language Pathologist: Consultant to the Cleft Lip and Palate Institute, Allied Health Professional Staff Appointment, Shriners Hospital for Children; Erin K McGraw, MA, CCC-SLP/L, Speech-Language Pathologist, Cleft Palate and Craniofacial Team, Shriners Hospital for Children-Chicago
Contributor Information and Disclosures

Updated: May 1, 2009

Multimedia

Anatomy of the palate.
(Enlarge Image)
Media file 1: Anatomy of the palate.
[ CLOSE WINDOW ]
Anatomy of the palate.

Anatomy of the palate.

The von Langenbeck repair. Two bipedicle mucoperi...
(Enlarge Image)
Media file 2: The von Langenbeck repair. Two bipedicle mucoperiosteal flaps are created by incising along the oral side of the cleft edges and along the posterior alveolar ridge from the maxillary tuberosities to the anterior level of the cleft. The flaps are then mobilized medially with preservation of the greater palatine arteries and closed in layers. The hamulus may need to be fractured to ease the closure.
[ CLOSE WINDOW ]
The von Langenbeck repair. Two bipedicle mucoperi...

The von Langenbeck repair. Two bipedicle mucoperiosteal flaps are created by incising along the oral side of the cleft edges and along the posterior alveolar ridge from the maxillary tuberosities to the anterior level of the cleft. The flaps are then mobilized medially with preservation of the greater palatine arteries and closed in layers. The hamulus may need to be fractured to ease the closure.

Two flap palatoplasty. After lateral relaxing inc...
(Enlarge Image)
Media file 3: Two flap palatoplasty. After lateral relaxing incisions are performed, bilateral flaps are elevated based on greater palatine vessels.
[ CLOSE WINDOW ]
Two flap palatoplasty. After lateral relaxing inc...

Two flap palatoplasty. After lateral relaxing incisions are performed, bilateral flaps are elevated based on greater palatine vessels.

Two-flap palatoplasty (continued). Closure of the...
(Enlarge Image)
Media file 4: Two-flap palatoplasty (continued). Closure of the nasal mucosa is performed. The hamulus may be fractured, the muscle is repaired, and the oral mucosa is closed as a separate layer.
[ CLOSE WINDOW ]
Two-flap palatoplasty (continued). Closure of the...

Two-flap palatoplasty (continued). Closure of the nasal mucosa is performed. The hamulus may be fractured, the muscle is repaired, and the oral mucosa is closed as a separate layer.

Double-opposing Z-plasties. Furlow's single-stage...
(Enlarge Image)
Media file 5: Double-opposing Z-plasties. Furlow's single-stage palatal closure technique consisting of double opposing Z-plasties from the oral and nasal surfaces. The double Z-plasty minimizes the need for lateral relaxing incisions to accomplish closure. The palate is lengthened as a consequence of the new position of the velar and pharyngeal tissues.
[ CLOSE WINDOW ]
Double-opposing Z-plasties. Furlow's single-stage...

Double-opposing Z-plasties. Furlow's single-stage palatal closure technique consisting of double opposing Z-plasties from the oral and nasal surfaces. The double Z-plasty minimizes the need for lateral relaxing incisions to accomplish closure. The palate is lengthened as a consequence of the new position of the velar and pharyngeal tissues.

Millard modification of Kernahan striped-Y classi...
(Enlarge Image)
Media file 6: Millard modification of Kernahan striped-Y classification for cleft lip and palate. The small circle indicates the incisive foramen; the triangles indicate the nasal tip and nasal floor.
[ CLOSE WINDOW ]
Millard modification of Kernahan striped-Y classi...

Millard modification of Kernahan striped-Y classification for cleft lip and palate. The small circle indicates the incisive foramen; the triangles indicate the nasal tip and nasal floor.

More on Craniofacial, Cleft Palate Repair

Overview: Craniofacial, Cleft Palate Repair
Workup: Craniofacial, Cleft Palate Repair
Treatment: Craniofacial, Cleft Palate Repair
Follow-up: Craniofacial, Cleft Palate Repair
Multimedia: Craniofacial, Cleft Palate Repair
References
[ CLOSE WINDOW ]

References

  1. Rogers B. Cleft palate surgery prior to 1816. In: McDowell F, ed. Source Book of Plastic Surgery. Baltimore:. Lippincott Williams & Wilkins;1977:248.

  2. Rogers B. History of cleft lip and palate treatment. In: Grabb WC, Rosenstein SW, Bzoch KR, eds. Cleft Lip and Palate: Surgical, Dental, and Speech Aspects. Little Brown & Co;1971:142-169.

  3. Veau V. La division palatine. Paris:. Masson et Cie;1931.

  4. Kilner TP. Cleft lip and palate repair techniques. St Thomas Hosp Rep. 1937;2:127.

  5. Wardill WE. The technique of operation for cleft palate. Br J Surg. 1937;25:117.

  6. Furlow LT Jr. Cleft palate repair by double opposing Z-plasty. Plast Reconstr Surg. Dec 1986;78(6):724-38. [Medline].

  7. Bardach J, Morris HL, Olin WH. Late results of primary veloplasty: the Marburg Project. Plast Reconstr Surg. Feb 1984;73(2):207-18. [Medline].

  8. Schweckendiek W, Doz P. Primary veloplasty: long-term results without maxillary deformity. a twenty-five year report. Cleft Palate J. Jul 1978;15(3):268-74. [Medline].

  9. Perko M. Two-stage palatoplasty. In: Bardach J, Morris HL, eds. Multidisciplinary Management of Cleft Lip and Palate. 1st ed. WB Saunders Co;1991:311-320.

  10. Peterson-Falzone SJ. A cross-sectional analysis of speech results following palatal closure. In: Bardach J, Morris HL, eds. Multidisciplinary Management of Cleft Lip and Palate. 1st ed. WB Saunders Co;1991:750-756.

  11. Bardach J, Mooney MP. The relationship between lip pressure following lip repair and craniofacial growth: an experimental study in beagles. Plast Reconstr Surg. Apr 1984;73(4):544-55. [Medline].

  12. Cohen M. Residual deformities after repair of clefts of the lip and palate. Clinics in Plastic Surgery. 2004;21(2):331-45. [Medline].

  13. da Silva Filho OG, Teles SG, Ozawa TO. Secondary bone graft and eruption of the permanent canine in patients with alveolar clefts: literature review and case report. Angle Orthod. Apr 2000;70(2):174-8. [Medline].

  14. Dufresne CR. Oronasal and nasolabial fistulas. In: Bardach J, Morris HL, eds. Multidisciplinary Management of Cleft Lip and Palate. 1st ed. WB Saunders Co;1991:425-436.

  15. Freni SC, Zapisek WF. Biologic basis for a risk assessment model for cleft palate. Cleft Palate Craniofac J. Oct 1991;28(4):338-46. [Medline].

  16. Hanson JW, Murray JC. Genetic aspect of cleft lip and palate. In: Bardach J, Morris HL, eds; Multidisciplinary Management of Cleft Lip and Palate. 1st ed. WB Saunders Co;1991:121-126.

  17. Hodges PL, Pownell PH. Cleft palate surgery and velopharyngeal function. Plast Surg. 1994;7(23):1-36.

  18. Johnston MC, Bronsky PT, Millicovsky G. Embryogenesis of cleft lip and palate. In: McCarthy JG, ed. Plastic Surgery. Vol 4. Philadelphia:. WB Saunders Co;1990:2515-2552.

  19. Kaufman FL. Managing the cleft lip and palate patient. Pediatr Clin North Am. Oct 1991;38(5):1127-47. [Medline].

  20. Kriens O. Anatomy of the velopharyngeal area in cleft palate. Clin Plast Surg. Apr 1975;2(2):261-88. [Medline].

  21. Lewis MB. Timing and technique of cleft palate repair. In: Marsh JL, ed. Current Therapy in Plastic and Reconstructive Surgery. Vol 1. Mosby-Year Book;1989.

  22. Lindsay WK. Surgical repair of cleft palate. Clin Plast Surg. Apr 1975;2(2):309-18. [Medline].

  23. Lubker JF. Normal velopharyngeal function in speech. Clin Plast Surg. Apr 1975;2(2):249-59. [Medline].

  24. Marsh JL, Grames LM, Holtman B. Intravelar veloplasty: a prospective study. Cleft Palate J. Jan 1989;26(1):46-50. [Medline].

  25. Maue-Dickson W, Dickson DR. Anatomy and physiology related to cleft palate: current research and clinical implications. Plast Reconstr Surg. Jan 1980;65(1):83-90. [Medline].

  26. Nguyen PN, Sullivan PK. Issues and controversies in the management of cleft palate. Clin Plast Surg. Oct 1993;20(4):671-82. [Medline].

  27. O'gara MM, Logemann JA. Early speech development in cleft palate babies. In: Bardach J, Morris HL, eds. Multidisciplinary Management of Cleft Lip and Palate. 1st ed. WB Saunders Co;1991:717-721.

  28. Peet E. The Oxford technique of cleft palate repair. Plast Reconstr Surg. 1961;28:282-294.

  29. Rohrich RJ, Byrd HS. Optimal timing of cleft palate closure. Speech, facial growth, and hearing considerations. Clin Plast Surg. Jan 1990;17(1):27-36. [Medline].

  30. Ross RB. Facial growth in cleft lip and palate. In: McCarthy JG, ed. Plastic Surgery. Vol 4. Philadelphia:. WB Saunders Co;1990:2553-2580.

  31. Sayetta RB, Weinrich MC, Coston GN. Incidence and prevalence of cleft lip and palate: what we think we know. Cleft Palate J. Jul 1989;26(3):242-7; discussion 247-8. [Medline].

  32. Schultz RC. Management and timing of cleft palate fistula repair. Plast Reconstr Surg. Dec 1986;78(6):739-47. [Medline].

  33. Silva Filho OG, Calvano F, Assuncao AG. Craniofacial morphology in children with complete unilateral cleft lip and palate: a comparison of two surgical protocols. Angle Orthod. Aug 2001;71(4):274-84. [Medline].

  34. Still MJ, Georgiade NG. Historical review of management of cleft lip and palate. In: Georgiade NG, ed. Symposium on Management of Cleft Lip and Palate. 1974:13.

  35. Von Langenbeck B. Operation on congenital total cleft of the hard palate by a new method. In: McDowell F, ed. The Source Book of Plastic Surgery. Baltimore:. Lippincott Williams & Wilkins;1977:307.

  36. Witzel MA, Salyer KE, Ross RB. Delayed hard palate closure: the philosophy revisited. Cleft Palate J. Oct 1984;21(4):263-9. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

cleft palate, cleft palate repair, facial cleft, cleft lip and palate, CL/P, cleft lip repair, cleft lip, birth defect, congenital defect, cleft lip surgery, cleft lip treatment, cleft lip feeding, cleft treatment, cleft lip pictures, cleft lip surgical repair, cleft lip repair pictures

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Raja Ramaswamy, MS, The Chicago Medical School
Raja Ramaswamy, MS is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Mitchell F Grasseschi, MD, Assistant Professor, Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University; Private Practice, Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Mary M O'Gara, MA, CCC-SLP, Associate Professor, Department of Plastic Surgery, Northwestern University Medical School; Speech/Language Pathologist: Consultant to the Cleft Lip and Palate Institute, Allied Health Professional Staff Appointment, Shriners Hospital for Children
Mary M O'Gara, MA, CCC-SLP is a member of the following medical societies: American Cleft Palate/Craniofacial Association and American Speech-Language-Hearing Association
Disclosure: Nothing to disclose.

Erin K McGraw, MA, CCC-SLP/L, Speech-Language Pathologist, Cleft Palate and Craniofacial Team, Shriners Hospital for Children-Chicago
Erin K McGraw, MA, CCC-SLP/L is a member of the following medical societies: American Cleft Palate/Craniofacial Association and American Speech-Language-Hearing Association
Disclosure: Nothing to disclose.

Medical Editor

Larry Hollier, Jr, MD, Assistant Professor, Department of Plastic Surgery, Baylor University College of Medicine
Larry Hollier, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, AO Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

S Anthony Wolfe, MD, Chief, Division of Plastic Surgery, Miami Children's Hospital; Voluntary Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami School of Medicine
S Anthony Wolfe, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic and Reconstructive Surgery, Florida Medical Association, and Southeastern Society of Plastic and Reconstructive Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.