Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Mucoperiosteal Flap Necrosis after Primary Palatoplasty in Patients with Cleft Palate

  • Received : 2015.05.09
  • Accepted : 2017.03.11
  • Published : 2017.05.22
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Abstract

Background The prevalence of flap necrosis after palatoplasty in patients with cleft palate. The prevalence of mucoperiosteal flap necrosis after palatoplasty remains unknown, and this complication is rare. This event is highly undesirable for both the patient and the surgeon. We present here a new scale to evaluate the degree of hypoplasia of the palate and identify patients with cleft palate at high risk for the development of this complication. Methods In this case series, a 20-year retrospective analysis (1994-2014) identified patients from our records (medical records and screening day registries) with nonsyndromic cleft palate who underwent operations at 3 centers. All of these patients underwent operations using 2-flap palatoplasty and also underwent a physical examination with photographs and documentation of the presence of palatal flap necrosis after primary palatoplasty. Results Palatal flap necrosis was observed in 4 cases out of 1,174 palatoplasties performed at these centers. The observed prevalence of palatal flap necrosis in these groups was 0.34%. Conclusions The prevalence of flap necrosis can be reduced by careful preoperative planning, and prevention is possible. The scale proposed here may help to prevent this complication; however, further studies are necessary to validate its utility.

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References

  1. Rossell-Perry P, Arrascue HM. The nasal artery musculomucosal cutaneous flap in difficult palatal fistula closure. Craniomaxillofac Trauma Reconstr 2012;5:175-84. https://doi.org/10.1055/s-0032-1322533
  2. Diah E, Lo LJ, Yun C, et al. Cleft oronasal fistula: a review of treatment results and a surgical management algorithm proposal. Chang Gung Med J 2007;30:529-37.
  3. Ibrahim A, Mshelbwala P, Obiadazie A, et al. A descriptive study of clefts of the primary and secondary palate seen in a tertiary health institution in Nigeria. Niger J Surg 2013;15:7-12. https://doi.org/10.4103/1595-1103.141384
  4. Deshpande GS, Campbell A, Jagtap R, et al. Early complications after cleft palate repair: a multivariate statistical analysis of 709 patients. J Craniofac Surg 2014;25:1614-8. https://doi.org/10.1097/SCS.0000000000001113
  5. Wardill W. The technique of operation for cleft palate. Br J Surg 1937;25:117-30. https://doi.org/10.1002/bjs.1800259715
  6. Ren S, Ma L, Sun Z, et al. Relationship between palate-vomer development and maxillary growth in submucous cleft palate patients. Cleft Palate Craniofac J 2014;51:314-9. https://doi.org/10.1597/12-051
  7. Hall BK, Precious DS. Cleft lip, nose, and palate: the nasal septum as the pacemaker for midfacial growth. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:442-7. https://doi.org/10.1016/j.oooo.2012.05.005
  8. Grzonka MA, Koch KH, Koch J, et al. Malformation of the vomer in submucous cleft palate. J Craniomaxillofac Surg 2001;29:106-10. https://doi.org/10.1054/jcms.2001.0199
  9. Bicknell S, McFadden LR, Curran JB. Frequency of pharyngoplasty after primary repair of cleft palate. J Can Dent Assoc 2002;68:688-92.
  10. Yuan N, Dorafshar AH, Follmar KE, et al. Effects of cleft width and veau type on incidence of palatal fistula and velopharyngeal insufficiency after cleft palate repair. Ann Plast Surg 2016;76:406-10. https://doi.org/10.1097/SAP.0000000000000407
  11. Veau V. Division palatine: anatomie, chirurgie, phonetique. Paris: Masson et cie; 1931.
  12. Rossell-Perry P. New diagram for cleft lip and palate description: the clock diagram. Cleft Palate Craniofac J 2009;46:305-13. https://doi.org/10.1597/08-070.1
  13. Rossell-Perry P, Caceres Nano E, Gavino-Gutierrez AM. Association between palatal index and cleft palate repair outcomes in patients with complete unilateral cleft lip and palate. JAMA Facial Plast Surg 2014;16:206-10. https://doi.org/10.1001/jamafacial.2013.2537
  14. Randall P, LaRossa D, McWilliams BJ, et al. Palatal length in cleft palate as a predictor of speech outcome. Plast Reconstr Surg 2000;106:1254-9. https://doi.org/10.1097/00006534-200011000-00003
  15. Woo AS. Velopharyngeal dysfunction. Semin Plast Surg 2012;26:170-7.
  16. Guneren E, Uysal OA. The quantitative evaluation of palatal elongation after Furlow palatoplasty. J Oral Maxillofac Surg 2004;62:446-50. https://doi.org/10.1016/j.joms.2003.05.015