Advanced intravelar veloplasty for asymmetrical soft palate cleft reconstruction

Purpose: Of 3518 patients, 2777 presented with a soft palate cleft (sP). Intravelar veloplasty (Kriens, 1969) (Type I) was used until 1987. This was modified according to anatomical defects (Bütow & Jacobs, 1991) (Type II). In 2008, the Type II was further modified (Type III) according to Sommerlad (2003) and Ivanov (2008). The surgical outcome was evaluated in respect of symmetry, appearance of uvula and occurrence of oro-nasal fistula.

Material and methods: A comparison was made between the results of the Type II and Type III procedures. Type III reconstruction entails a long axial dissection of the uvula, on the cleft longer side and its insertion into the nasal layer of a perpendicular releasing incision on the shorter side. Levator muscles are extensively released and rotated posteriorly. Released palatoglossal-palatopharyngeal muscle bundles are connected. Group A patients, with asymmetrical sP underwent Type II (2005–2008), and were compared to Group B patients who underwent Type III (2008–2011), reconstruction.

Results: Total of 239 sP were reconstructed: 144 according to Type II, 95 to Type III. 20 asymmetrical sP had a Type II; 17 a Type III. The reconstructed sP remained asymmetrical in 45.0% Type II and 5.0% Type III. Oronasal fistula occurred in 15.0% Type II and none Type III. Uvula appeared subjectively abnormal in 65% of Type II, and 11.8% of Type III. Type III resulted in less asymmetry.

Conclusion: Reconstruction of the asymmetrical soft palate cleft is challenging. Type III addresses asymmetry and function.

Conflict of interest: None declared.

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Jan 27, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Advanced intravelar veloplasty for asymmetrical soft palate cleft reconstruction
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