Isolated Cleft Palate Correction

This is a 10 months old baby with an isolated cleft of hard and soft palate. This is one of the milder versions of the palatal clefts. To close this type of cleft, an intraoral approach is done where in a vomerine flap is raised. The nasal layer is raised. Through the incision on the hard palate, a palatal flap is also raised. The greater palatine artery is exposed. At this juncture, the nasal mucosa is carefully separated. An osteotomy of the greater palataine foramen and canal is carried with great dexterity to prevent post operative tension that could lead to potential problems. The medial and lateral flaps of the mucogingival flaps are also carried out. Using a Howarth Elevator, the palatal mucosa is elevated. Care is exercised not to disturb the tooth buds. While operating in the opposite or the contra lateral side, the left hand is used for incising. Hence this surgery would be best performed by an ambidextrous surgeon. The nasal mucosa is sutured to create an ideal nasal cavity.
The muscle attachments are carefully identified. The leveator palati is detached and the correct attachment is performed. Throughout the procedure, the greater palantine vessels are carefully handled. The muscle sling is established. The greater palatine artery is moved away from the canal to aid in repositioning of the flap.
At the end of this procedure, suturing is commenced from Anterior to Posterior direction then towards the uvula. A horizontal or a vertical mattress type of suture is placed. Dead space between nasal and palatal mucosa should be eliminated. For this reinforcement bite is placed even from the nasal mucosa