DOI QR코드

DOI QR Code

A novel modification of Bardach's two-flap palatoplasty for the repair of a difficult cleft palate

  • Mir, Mohd Altaf (Department of Burns and Plastic Surgery, All India Institute of Medical Sciences) ;
  • Manohar, Nishank (Department of Burns and Plastic Surgery, All India Institute of Medical Sciences) ;
  • Chattopadhyay, Debarati (Department of Burns and Plastic Surgery, All India Institute of Medical Sciences) ;
  • Mahakalkar, Sameer S (Department of Burns and Plastic Surgery, All India Institute of Medical Sciences)
  • Received : 2020.03.14
  • Accepted : 2020.06.27
  • Published : 2021.01.15

Abstract

Bardach described a closure of the cleft utilizing the arch of the palate, which provides the length needed for closure and is most effective only in narrow clefts. Herein, we describe a case where we utilized Bardach's two-flap technique with a vital and easy modification, done to allow closure of a wide cleft palate and to prevent oronasal fistula formation at the junction of the hard and soft palate, which are otherwise difficult to manage with conventional flaps. The closed palate showed healthy healing, palatal lengthening, and no oronasal regurgitation. We advise using this modification to achieve the goals of palatal repair in difficult cases where tension-free closure would otherwise be achieved with more complex flap surgical techniques, such as free microvascular tissue transfer.

Keywords

References

  1. Thomas C. Repair of cleft palate: evolution and current trends. J Cleft Lip Palate Craniofac Anomal 2015;2:6-10. https://doi.org/10.4103/2348-2125.150704
  2. Bardach J. Two-flap palatoplasty: Bardach's technique. Oper Tech Plast Reconstr Surg 1995;2:211-4. https://doi.org/10.1016/S1071-0949(06)80034-X
  3. Leow AM, Lo LJ. Palatoplasty: evolution and controversies. Chang Gung Med J 2008;31:335-45.
  4. Trier WC, Dreyer TM. Primary von Langenbeck palatoplasty with levator reconstruction: rationale and technique. Cleft Palate J 1984;21:254-62.
  5. Paniagua LM, Collares MV, Costa SS. Comparative study of three techniques of palatoplasty in patients with cleft of lip and palate via instrumental and auditory-perceptive evaluations. Int Arch Otorhinolaryngol 2010;14:18-31.
  6. Furlow LT Jr. Cleft palate repair by double opposing Z-plasty. Plast Reconstr Surg 1986;78:724-38. https://doi.org/10.1097/00006534-198678060-00002
  7. Mann RJ, Fisher DM. Bilateral buccal flaps with double opposing Z-plasty for wider palatal clefts. Plast Reconstr Surg 1997;100:1139-45. https://doi.org/10.1097/00006534-199710000-00009
  8. LaRossa D, Jackson OH, Kirschner RE, et al. The Children's Hospital of Philadelphia modification of the Furlow double-opposing Z-palatoplasty: long-term speech and growth results. Clin Plast Surg 2004;31:243-9. https://doi.org/10.1016/S0094-1298(03)00141-X
  9. Aboul-Wafa AM. Islandized mucoperiosteal flaps: a versatile technique for closure of a wide palatal cleft. Can J Plast Surg 2012;20:173-7. https://doi.org/10.1177/229255031202000306
  10. Yamaguchi K, Lonic D, Lee CH, et al. Modified Furlow palatoplasty using small double-opposing Z-plasty: surgical technique and outcome. Plast Reconstr Surg 2016;137: 1825-31. https://doi.org/10.1097/PRS.0000000000002181
  11. Yamaguchi K, Lonic D, Lo LJ. Modified Furlow palatoplasty using small double-opposing Z-plasty for patients with cleft lip and/or palate. Plast Reconstr Surg Glob Open 2016;4 (9S):16. https://doi.org/10.1097/01.GOX.0000502895.92370.cf