Modified Von Langenbeck cleft palate repair using an anterior triangular flap: decreased incidence of anterior oronasal fistulas.
OBJECTIVE
A complication following cleft palate surgery is the development of oronasal fistulas. Despite recent advances aimed at addressing this concern, rates of postoperative fistulas have remained unchanged and are reported at between 3% and 60%. Oronasal fistulas commonly occur between the hard and soft palate and at the anterior portion of the cleft. These fistulas lead to functional problems with nasal emission, hypernasal speech, and food regurgitation through the nose. For clefts of the secondary palate, we developed a modification of the Von Langenbeck technique in which an anterior triangular flap is used to decrease the incidence of postoperative fistulas.


METHODS
A triangular flap composed of oromucosa was designed for isolated clefts of the secondary palate only. It is based at the anterior margin of the cleft and is used as a turnover flap to allow closure of the often very tight anterior nasal side. A retrospective chart analysis was performed from 2000 to 2007. All patients who had isolated clefts of the secondary palate and had undergone a modified Von Langenbeck procedure were included in the study. Patients were evaluated 4 to 8 weeks postoperatively for the presence of oronasal fistulas.


RESULTS
With the introduction of the anterior triangular flap, we show that 0 of 182 patients developed a postoperative oronasal fistula.


CONCLUSIONS
This modification of the standard Von Langenbeck uses an anterior triangular flap and confers the advantage of assisting in nasal side closure of the anterior margin of the cleft; in doing so, it reduces the rate of fistula formation.
Stewart
Tara Lynn
TL
Division of Pediatric and Plastic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Fisher
David M
DM
Olson
Jaret L
JL
D002972:Cleft Palate / Q000145:classification / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation*; D009296:Nasal Cavity / Q000601:surgery; D009297:Nasal Mucosa / Q000601:surgery; D009668:Nose Diseases / Q000517:prevention & control*; D016155:Oral Fistula / Q000517:prevention & control*; D021362:Palate, Hard / Q000601:surgery; D010160:Palate, Soft / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D016156:Respiratory Tract Fistula / Q000517:prevention & control*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000145:classification*; D013536:Suture Techniques