Cleft palate: historical treatments and current management


  • Daniel Fernando Narvaez Hernandez Hospital General Dr. Ruben Leñero, Ciudad de México, Mexico
  • Alexis Andrei Granados Flores Hospital General Regional, Ciudad Juárez, Chihuahua, México
  • Daniela Fernanda Carpio Escobar Hospital Regional de alta especialidad ISSSTE Veracruz, Mexico
  • María Idalia Padilla Salazar Escuela Nacional de Medicina y Homeopatía, Mexico
  • Luis Fernando Ochoa Meza Hospital General ISSSTE Lazaro Cardenas, Chihuahua, Mexico
  • Manuel Fonseca Orozco Universidad de Guanajuato, Mexico
  • María Isabel Sixtos Serrano Universidad Nacional Autónoma de Mexico, Mexico
  • Daniela Medina Correa IMSS Hospital General Regional, “Gral. José Vicente Villada” Toluca, Edo. De México, Mexico
  • José Fernando Montiel Castañeda Hospital General de Ensenada, Mexico



Free flap, Microsurgery, Cleft palate


The soft palate is an indispensable anatomical component that serves crucial functions such as airway maintenance, swallowing facilitation, and speech enablement. Significant morbidity results from excisional surgery that disturbs the functional architecture of the soft palate; furthermore, the intrinsic velar musculature cannot be adequately restored with prosthetic or flap reconstructions. When managing oral malignancies that affect the soft palate, achieving oncological control and reducing the incidence of complications and adverse effects are the principal goals. In the contemporary era of microsurgical practice, research groups are not solely focused on achieving successful flap procedures and oncological excision, but also on improving functional outcomes. A suprafascial ALT flap was surgically constructed in this instance to optimize the functionality of the remaining velar muscles and provide additional volume. The method of treatment is determined by the defect's dimensions and the anatomical components that are extracted. It is advisable to perform direct repair for full-thickness injuries. However, nonanatomic reconstruction is employed for full-thickness injuries that are "near-total to total," or exceeding 70%, with the addition of a fascial splint to restrict the velopharynx. A two-layer closure technique, the use of a fascial sling, the positioning of the skin vessel/perforator, the incorporation of the vastus lateralis muscle, the maintenance of a minimal distance between the point of entry into the muscle and the point where the perforator branches off, and the verification of the muscle's vitality prior to finalizing the closure are all recommended approaches for managing velopharyngeal constriction. In summary, the utilization of an anterolateral thigh (ALT) free flap technique in palate reconstruction yields advantageous functional outcomes while minimizing donor site complications.


Marani E, Heida C, Marani E, Heida C. Oral Cavity: Tongue, Palate and Teeth. Head Neck Morphol Models Function. 2018;11:133-60.

Liu H. Modeling and simulation of the soft palate for improved understanding of the obstructive sleep apnea syndrome; 2018.

Kuruppumullage DN. Biomechanical models of human upper and tracheal airway functionality; 2018.

Berkovitz BK. Anatomy and Embryology of the Mouth and Dentition. In Scott-Brown's Otorhinolaryngology and Head and Neck Surgery. CRC Press; 2018: 633-656.

Prasad V, Chhodon L, Aravindhan A, Zaidi SJA. Prosthetic rehabilitation of patients with cleft lip and palate. J Cleft Lip Palate Craniofacial Anomalies. 2022;9(2):189-96.

Schönmeyr B, Wendby L, Sharma M, Jacobson L, Restrepo C, Campbell A. Speech and speech-related quality of life after late palate repair: a patient's perspective. J Craniofacial Surg. 2015;26(5):1513-6.

Markkanen-Leppänen M. Functional outcome after free flap reconstructions in oral and pharyngeal cancer; 2006.

Marchi F, Wei FC. Microsurgical Procedures in Plastic Surgery. Textbook of Plastic and Reconstructive Surgery: Basic Principles and New Perspectives. 2022;12:125-39.

Eckstein DA, Wu RL, Akinbiyi T, Silver L, Taub, PJ. Measuring quality of life in cleft lip and palate patients: currently available patient-reported outcomes measures. Plastic Reconstruct Surg. 2011;128(5):518e-526e.

Kuo YR, Jeng SF, Kuo MH, Liu YT, Lai PW. Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: review of 140 cases. Ann Plastic Surg. 2002;48(2):161-6.

Carstens MH. Pathologic Anatomy of the Soft Palate. In The Embryologic Basis of Craniofacial Structure: Developmental Anatomy, Evolutionary Design, and Clinical Applications. Cham: Springer International Publishing; 2023: 1389-1435.

Guerrerosantos J, Chicas M, Rivera H. Palatopharyngeal lipoinjection: an advantageous method in velopharyngeal incompetence. Plastic and Reconstruct Surg. 2004;113(2):776-7.

Kämmerer PW, Al‐Nawas B. Bone reconstruction of extensive maxillomandibular defects in adults. Periodontology. 2000;93(1):340-57.

Samman N, Cheung LK, Tideman H. The buccal fat pad in oral reconstruction. Int J Oral Maxillofacial Surg. 1993;22(1):2-6.

Hopper RA, Tse R, Smartt J, Swanson J, Kinter S. Cleft palate repair and velopharyngeal dysfunction. Plastic Reconstruct Surg. 2014;133(6):852e-64e.

Schliephake H, Hausamen JE. Cleft lip and palate. In Oral and maxillofacial surgery: Surgical textbook and atlas. Berlin, Heidelberg: Springer Berlin Heidelberg; 2023: 331-386.

Reddy SG, Fanan A. Complications in Cleft Lip and Palate Surgeries. Complications Cranio-Maxillofacial Oral Surg. 2020;10:3-32.

Escobar DFC. Updates in microsurgical technique for cleft palate reconstruction; 2024.

Landesberg R, Di Pasquale LM. Osteoradionecrosis/osteonecrosis of the jaws. Oral Maxillofacial Surg. 2005;5:443.

Wolff K, Hölzle F. Raising of microvascular flaps: a systematic approach. Springer Sci Business Media; 2005.

Clemente CD. Clemente's anatomy dissector: guides to individual dissections in human anatomy with brief relevant clinical notes (applicable for most curricula). Lippincott Williams & Wilkins; 2010.

Rappaport NH, Netscher DT. Plastic surgery techniques applicable to periodontal flap surgery. Periodontology. 1996;11(1):95-102.

Based AD, Ilankovan V, Ethunandan M, Seah TE. Local flaps in facial reconstruction. Springer: Berlin/Heidelberg, Germany; 2007.

Reckley LK, Peck JJ, Roofe SB. Flap basics III: interpolated flaps. Facial Plastic Surg Clin. 2017;25(3):337-46.

Fernandes R. Local and regional flaps in head and neck reconstruction: a practical approach. John Wiley & Sons; 2014.






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