A Technique for Cleft Palate Repair

TLDR

The authors describe a microsurgical palate repair that uses minimal hard palate dissection, radical retropositioning of the velar musculature, and tensor tenotomy, applied to 442 primary cleft palate cases with over ten years of follow‑up. The technique achieved an 80 % rate of margin‑only incisions, reduced secondary velopharyngeal insufficiency from 10.2 % to 4.6 % over 15 years, and independent speech assessments indicate improved velar function.

Abstract

The author has developed a technique of palate repair that combines minimal hard palate dissection with radical retropositioning of the velar musculature and tensor tenotomy. The repair is performed under the operating microscope. Results are reported for 442 primary palate repairs performed between 1978 and 1992 inclusive, with follow-up of at least 10 years. In 80 percent of these palate repairs, repair was carried out through incisions at the margins of the cleft and without any mucoperiosteal flap elevation or lateral incisions. Secondary velopharyngeal rates have decreased from 10.2 to 4.9 to 4.6 percent in successive 5-year periods within this 15-year period. Evidence from independent assessment of speech results in palate re-repair and submucous cleft palate repair suggests that this more radical muscle dissection improves velar function.