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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
Rivista di Chirurgia Maxillo-Facciale
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2012 Dicembre;23(1-3):27-33
The musculo-nasomucosal unit with complete lateral bony freeing and medial rotation for ideal C-shape restoration and retro-positioning of the levator veli palatini. A technical overview in 74 patients undergoing palatal lengthening surgery
El-Shafiey H. 1, El-Shazly M. 2
1 Department of Ear, Nose and Throat, Assiut University, Assiut, Egypt;
2 Department of Plastic Surgery, Assiut University, Assiut, Egypt
Aim. No definitive procedure for cleft repair has been identified yet as the gold standard. Accordingly, this work tried to appraise the hypothesis that if the bony detachment and full retro-positioning of the levator veli palatini muscle can ideally present an anatomical C-shape muscular sling restoration and if this is accompanied with pushback palatoplasty; would this present better result in terms of tissue fistulaion and phonetic impairment.
Methods. A series of 74 different degrees of palatal clefts were operated by pushback palatoplasty combined with a modified approach of the levator vili palatini. This muscle was dissected only from the oral mucosa while kept attached to the nasal one as a musculo-nasomucosal unit. This unit was completely detached from the bony margin of the hard palate and then medially rotated and retro-positioned in a typical C-shape mobile sling. Evaluations included suture line assessment and fistula development, and following the child’s need for speech therapy.
Results. There were no intraoperative complications. Definite anterior fistulae with nasal air and foot leakage were observed in two cases. Four cases had postoperative velopharyngeal incompetence with a need for speech therapy.
Conclusion. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all cleft types, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this un-published technique.