Cleft Palate Repair
Objective
In cases of cleft palate:
• Repair of congenital defects in the palate.
Position
Supine with head extended with a pillow under the shoulders and ring under the head.
Anesthesia
General with a flexometallic or oxford endotracheal tube secured on the middle of the lower lip.
Procedure
1. Place mouthgag.
2. General anesthesia through an endotracheal tube.
3. A local anesthetic containing epinephrine is infiltrated to aid hemostasis.
4. Defect, soft palate margins are incised.
5. Layers for oral mucosa, muscle, and nasal mucosa are developed.
6. The pterygoid hamulus is fractured.
7. Mucoperiosteal flaps are elevated.
8. Nasal mucosal flaps are freed and sutured.
9. The nasal mucosa of the soft palate is sutured.
10. Holes may be drilled in the hard palate for suture placement.
11. Bone grafts may be employed.
12. Muscle layers, and the oral mucosa are sutured.
Instruments
• Plastic limited procedure set
• Mouthgag-Dingman or Dott (Fig. 18.19)
• Long knife handle with No. 12, and No. 15 and No. 11 blade (BP)
• Freer periosteum elevator (Fig. 14.33)
• Curved elevators angled right and left
• Barsky pharyngeal flap elevator (Fig. 18.20)
• Osteotome 3 mm
• Mallet
• Long fine dissecting forceps toothed (Gilles, McIndoe) (Fig. 8.49)
• Suction tubing with fine suction tip
• Sterile gauze cut into halves and quarters.
Sutures
• 4 ‘0’ Vicryl or catgut on curved cutting 5/8 circle needle
• 4/0 Silk on curved cutting needle for stay sutures.
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Any questions be sent to drmmkapur@gmail.com
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