Cleft palate repair using a marginal musculo-mucosal flap.
OBJECTIVE
To describe a modified procedure consisting of a mucoso-periosteal flap palatoplasty with a marginal musculo-mucosal flap (3M flap). This is also the first report of a primary repair for complete cleft palate using the 3M flap. We describe the lengthening effect of the nasal mucous layer of the soft palate and evaluate the fistula formation rate associated with this method.


METHODS
This procedure has been performed on 21 patients with unilateral complete clefts and on 27 patients with incomplete clefts. A mucoso-periosteal flap raised from the hard palate was used mainly for closure of the cleft and not for the push-back. The 3M flap repaired the deficit of the nasal mucosa, making sure that the soft palate was lengthened. Intravelar veloplasty was performed also.


RESULTS
The dimension of the nasal mucosal defect that can be filled with the 3M flap is 10 to 12 mm in length, oriented anterior-posterior, and 15 to 20 mm wide. Oronasal fistula formation was recognized in only 3 of 48 cases (2 of 21 complete clefts, 1 of 27 incomplete clefts) and were located at the hard-soft palate junction at the anterior portion of the 3M flap.


CONCLUSIONS
This method has the theoretical advantages of (1) preventing fistula formation by filling the tissue deficiency with the 3M flap; (2) achieving better velopharyngeal function due to elongation of the soft palate and retropulsion of the muscular bundle, utilizing the 3M flap; and (3) minimizing maxillary growth retardation by adopting a non-push-back method of hard palate repair.
Ogata
Hisao
H
Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. prsogata@sc.itc.keio.ac.jp
Nakajima
Tatsuo
T
Onishi
Fumio
F
Tamada
Ikkei
I
Hikosaka
Makoto
M
D001684:Biological Dressings; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D006801:Humans; D007223:Infant; D009297:Nasal Mucosa / Q000637:transplantation*; D009668:Nose Diseases / Q000209:etiology; D016155:Oral Fistula / Q000209:etiology; D010156:Palatal Muscles / Q000637:transplantation*; D021362:Palate, Hard / Q000601:surgery; D010160:Palate, Soft / Q000601:surgery; D010521:Periosteum / Q000637:transplantation; D011183:Postoperative Complications; D016156:Respiratory Tract Fistula / Q000209:etiology; D013524:Surgical Flaps; D013536:Suture Techniques