Background and objectives : Many techniques are available to repair clefts of the palate. Techniques involving substantial stripping of the palatal mucoperiosteum, lead to maxillary hypoplasia. Vomerine flaps have been proven to be less detrimental to maxillary growth; however, they are technique sensitive. Cranially-based vomerine flaps are easier to create than caudally-based flaps, especially in narrower clefts, but a palatal groove formation often occurs upon healing. Maintenance of the blood-clot in the exposed flap bed would prevent this phenomenon. Utilization of a resorbable sheet in combination with the flap, may not only preserve the blood-clot, but also support the flap repair. PDLLA sheets generally take between 6 and 9 months to resorb.
Methods : Ten patients presenting with complete clefts of the lip and palate (CLAP) were treated by using cranially-based vomerine flaps in combination with the placement of resorbable Poly-d- & l -Lactic Acid sheets (PDLLA, KLS-Martin). No other changes were made to the standard mirror-image treatment protocol (University of Pretoria) for these patients. The patients were followed up for an average of 13.4 months (range 9–24), by means of visual inspection and observation for nasal regurgitation at regular follow-up visits. Their results were compared to patients who have previously had cranially-based vomerine flap repairs done, without placement of resorbable sheets.
Results : All of the repaired clefts of the hard palate healed completely and uneventfully with no major complications. On inspection, no groove formation was observed, compared to controls.
Conclusion : Utilising a PDLLA resorbable sheet in combination with a cranially-based vomerine flap is a very promising technique. It has yielded very high success rates for cleft repair and no groove formation in the palate.
Key words: cleft hard palate; vomerine flap; PDLLA sheet