Microsurgical repair of the soft cleft palate.

A new microsurgical closure of the soft cleft palate was done in ten cases. The essence of the surgical procedure is summarized in three points; 1) a pancaked shaped musculomucosal flap of the soft palate and if necessary mucoperiosteal flap of the hard palate, 2) a whole layer Z-plasty at the palatopharynge:l muscle region, and 3) muscle sling of the levator veli palatini muscle. This surgical approach never exposes the retromolar region, which is a growth center, nor reveres the lesser palatine nerve. Therefore, we expect a he ter grow growth of the maxillary and palatal bones, and less chance of anesthesia of the soft palate and of atrophy of the mucosal gland. The push-back procedure by Wardilh is a basic surgical technique of the cleft palate. Since then, Cronin,2 Millard3 and et al. have reported the refined techniques. Contrary to these static surgical procedures, Edgerton,4 Skoog5, and Randallh have developed a concept of dynamic cleft palate surgery, a muscle sling of the levator veli palatini muscle. However, there are still some unphysiological and unsolved problems ; an unavoidable severence of the lesser palatine neuro vascular bundle in order to have a satisfactory retroposition of the palate, thus developing an atrophy of the uvula muscle and the mucosal gland, and anesthesia of the soft palate, leading possibly to an incompetent velopharyngeal closure ; a reverence of the tendon of the tensor veli palatini muscle or a fracture of the hamulus process in order to obtain an easy approximation of the cleft palate at the midline, and a possible interference of the normal bony apposition around the retromolar region, where is growth center, due to a scar tissue formation resulting from the para-alveolar and retromolar incisions during the push-back procedure. In order to avoid such the problems, a new microsurgical approach has been innovated and will be reported in case of the soft cleft palate.