title: Evolution in minimal-incision palatoplasty: surgical technique and outcomes in 67 consecutive cases.
abstract: BACKGROUND
  Conventional palatoplasty relies on extensive mucosal incisions and isolation of flaps on the palatine vessels to facilitate midline closure and velar reconstruction. This introduces substantial scarring, which has adverse effects on vascularity and growth. The authors have developed a minimally invasive palatoplasty technique that may have advantages over traditional techniques. The authors present their operative experience and outcomes when using the minimally invasive method paired with a novel cranial base maneuver for nasal mucosa closure.
  
  
  METHODS
  Based on cadaveric dissections, the authors developed a modified minimal-incision approach that permits anatomical reconstruction from a midline approach. From 2003 to 2010, a retrospective review was performed on 67 consecutive minimal-incision palatoplasties. Cases requiring relaxing incision and/or conversion to other palatoplasty techniques were compared with minimal incision alone.
  
  
  RESULTS
  Minimally invasive palatoplasty alone was able to be performed in 78 percent (n=52) of all cases. Fistula rates were 7.6 percent (n=4) in the minimally invasive palatoplasty group and 20 percent (n=3) in the relaxing/conversion group (p=0.04). Of patients requiring relaxing incisions/conversion, a higher percentage were syndromic (73 percent; p=0.01). Eighty-nine percent of all Veau class I defects were able to be successfully closed with the minimally invasive palatoplasty approach (p=0.01).
  
  
  CONCLUSIONS
  Minimal-incision palatoplasty paired with a cranial base maneuver for nasal mucosa elevation results in adequate soft-tissue mobility and length to arrive at a tension-free closure. Fistula and velopharyngeal insufficiency rates are comparable to that of other techniques, and theoretical advantages of this technique will be borne out by longer term follow-up.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Cincinnati, Ohio From the Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati Medical Center.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Pan
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Rapp
authors.forename: Anthony
authors.initials: A
authors.lastname: Vu
authors.forename: Armando
authors.initials: A
authors.lastname: Uribe-Rivera
authors.forename: David A
authors.initials: DA
authors.lastname: Billmire
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Gordon
mesh_terms: D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome