title: Pathology of the palatal aponeurosis in cleft palate.
abstract: OBJECTIVE
  The palatal aponeurosis is a controversial structure, both in terms of its anatomy and its function. This article points out a pathologic finding in the cleft palate condition that has not been previously described.
  
  
  METHODS
  By means of surgical dissections, this study demonstrates in detail that the palatal aponeurosis exists even in cleft palates, but it is disrupted, malpositioned, and folded in two layers.
  
  
  METHODS
  This dissection method has been performed on more than 150 patients with cleft of the hard and soft palate, with or without cleft of the lip and alveolus. At the time of operation, the children were between 6 and 8 months of age.
  
  
  RESULTS
  It is possible to dissect the two layers of the palatal aponeurosis, to unfold the aponeurosis, and to form a tough tendinous plane.
  
  
  CONCLUSIONS
  For a functional physiologic reconstruction of the cleft palate, it is necessary not only to reconstruct the levator veli palatini and palatopharyngeus muscle slings, but also to approximate and suture the fibers of the palatal aponeurosis to the corresponding fibers of the opposite side after unfolding them in a medio-dorso-cranial direction. In this manner, a continuous palatal aponeurosis can be created, which subsequently can serve as a transmitter of the muscle forces.
authors.affiliation: Department of Cleft Lip, Alveolus, Hard and Soft Palate, Friedrich-Zimmer Hospital, Herborn, Germany.
authors.forename: K H
authors.initials: KH
authors.lastname: Koch
authors.forename: M A
authors.initials: MA
authors.lastname: Grzonka
authors.forename: J
authors.initials: J
authors.lastname: Koch
mesh_terms: D002972:Cleft Palate / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D008722:Methods; D010160:Palate, Soft / Q000473:pathology* / Q000601:surgery; D013524:Surgical Flaps