Double elongations of partially cleft palates and elongations of palates with complete clefts
1940; Elsevier BV; Volume: 26; Issue: 9 Linguagem: Inglês
10.1016/s0096-6347(40)90059-x
ISSN1557-847X
Autores Tópico(s)Congenital Anomalies and Fetal Surgery
ResumoA METHOD of elongating partially cleft palates was described in 1936,* the principle of which is that practically the entire soft tissue of the palate is freed from the bone, the major palatine arteries are loosened but not cut, and the entire mass of tissue is immediately set back-as a direct flap with preservation of its arterial supply-so that the anterior part, from just behind the incisors, is anchored all the way back at the posterior border of the bone. A gain in length is thus obtained equal to about as much as the expanse of denuded bone, the object being to have the longest possible functioning palate, to assist in nasopharyngeal closure in speaking and eating. Some of the original illustrations of the procedure in Figs. 1 to 4 show the complete freeing of the tissues from the bone, the preservation of the arteries and the anchoring of the palate to a little bridge of nasal mucosa that has been left behind for this purpose. The closure of the cleft itself is done usually at the same operation-as a preliminary step-in children, but may be done as a separate operation. In adults two stages are advisable because of excessive bleeding. The sequence of the elongation and the closure does not have to follow a definite rule; therefore, a field is opened for older children and even adults, who have had clefts closed many years before, to have their palates elongated in an effort to obtain better speech. Observations made or emphasized since the original publication may be summarized, as follows : 1. It is still thought that the direct flap, elevated and immediately set back, so that the least possible thickening will take place, is superior to the delayed flap method of elongation. 2. Preservation of the major palatine arteries (often called the posterior) is possible in nearly all patients, and freeing is effected by careful loosening of all tissue around the artery, gently stretching it from the foramen and, if necessary, carefully cutting it away from the palate flap. These methods have seemed better than trying to dislodge the artery from its bony canal by trying to remove the posterior wall of the canal. The palate may be gotten so free by this dissection plus complete separation of the aponeurosis from the bone that it may be easily “set-back,” practically against the posterior pharyngeal wall in most instances. This finding is in contradistinction to that of others who think that preservation of the arteries prevents elongation. This may seem somewhat of an equivocal point but it makes possible closure and elongation in a single stage, and it may give a less scarred and
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