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Cleft Palate Repair Workup

  • Author: Pravin K Patel, MD; Chief Editor: Jorge I de la Torre, MD, FACS  more...
 
Updated: Feb 05, 2016
 

Laboratory Studies

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  • Routine laboratory studies are noncontributory in otherwise healthy infants with cleft palate. Some centers obtain a blood count as a routine study before performing surgery on a child with cleft palate. The authors do not find this necessary unless some other associated medical conditions coexist.
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Imaging Studies

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  • Routine imaging studies are noncontributory in otherwise healthy infants who undergo primary cleft palate repair.
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Diagnostic Procedures

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  • Early collaboration with an audiologist and an otolaryngologist, including examination and early audiologic assessment, prevents long-term hearing deficits.
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Contributor Information and Disclosures
Author

Pravin K Patel, MD Chief of Craniofacial Surgery and Professor of Surgery, Division of Plastic Surgery, University of Illinois College of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children

Disclosure: Nothing to disclose.

Coauthor(s)

Raja Ramaswamy, MS Chicago Medical School at Rosalind Franklin University of Medicine and Science

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, Northwestern University, The Feinberg School of Medicine; 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, American Speech-Language-Hearing Association

Disclosure: Nothing to disclose.

Erin K McGraw, MA, CCC-SLP/L Speech-Language Pathologist, Cleft Palate and Craniofacial Team, Shriner's Hospital for Children of Chicago

Erin K McGraw, MA, CCC-SLP/L is a member of the following medical societies: American Cleft Palate-Craniofacial Association, American Speech-Language-Hearing Association

Disclosure: Nothing to disclose.

Stephanie Cohen, MD, MS Resident Physician, Department of Plastic and Reconstructive Surgery, University of Illinois College of Medicine

Stephanie Cohen, MD, MS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Cleft Palate-Craniofacial Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society of Plastic Surgeons, Florida Medical Association, Southeastern Society of Plastic and Reconstructive Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Additional Contributors

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: AO Foundation, Alpha Omega Alpha, American Cleft Palate-Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Alexander Margulis MD, Kara K Criswell MD, and Bryan K Criswell MD to the development and writing of this article.

References
  1. Ysunza PA, Repetto GM, Pamplona MC, et al. Current Controversies in Diagnosis and Management of Cleft Palate and Velopharyngeal Insufficiency. Biomed Res Int. 2015. 2015:196240. [Medline]. [Full Text].

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

  3. 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.

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

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

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

  7. Figueiredo JC, Ly S, Magee KS, et al. Parental risk factors for oral clefts among Central Africans, Southeast Asians, and Central Americans. Birth Defects Res A Clin Mol Teratol. 2015 Oct. 103 (10):863-79. [Medline].

  8. Chen Q, Zheng Q, Shi B, Yin H, Meng T, Zheng GN. Study of relationship between clinical factors and velopharyngeal closure in cleft palate patients. J Res Med Sci. 2011 Jul. 16(7):945-50. [Medline]. [Full Text].

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

  10. Teng E, Steinbacher DM. Repair of the Cocaine-induced Cleft Palate Using the Modified Double-opposing Z-plasty. Cleft Palate Craniofac J. 2012 Jan 22. [Medline].

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

  12. Black JS, Gampper TJ. Transverse mucoperiosteal flap inset by rotation for cleft palate repair: technique and outcomes. Ann Plast Surg. 2014 Jun. 72(6):S90-3. [Medline].

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

  14. 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.

  15. 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.

  16. Jones CM, Mackay AF, Mackay DR, Long RE. Do Pharyngeal Flaps Restrict Early Midface Growth in Patients with Clefts?. Cleft Palate Craniofac J. 2016 Jan 11. [Medline].

  17. Follmar KE, Yuan N, Pendleton CS, et al. Velopharyngeal Insufficiency Rates After Delayed Cleft Palate Repair: Lessons Learned From Internationally Adopted Patients. Ann Plast Surg. 2014 Jul 18. [Medline].

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

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Anatomy of the palate.
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 incisions are performed, bilateral flaps are elevated based on greater palatine vessels.
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 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 classification for cleft lip and palate. The small circle indicates the incisive foramen; the triangles indicate the nasal tip and nasal floor.
 
 
 
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