Non routine use of alveolar incision in Von Langenbeck technique palatoplasty in children; a safe and viable technique in our centre

Authors

  • Philemon E. Okoro Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
  • Benjamin M. Kejeh Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

DOI:

https://doi.org/10.18203/2349-2902.isj20192941

Keywords:

Children, Cleft palate, Lateral incision, Outcome, Palatoplasty, von Langenbeck

Abstract

Background: Repair of the palate is among the challenging reconstructive surgeries in children. No single technique has achieved completely satisfactory results. The von Langenbeck technique (VLT) is one of the techniques in common use. We have sort to find out if the lateral alveolar incision in VLT can be safely avoided in selected cases.

Methods: This is a prospective comparative study of cases of isolated unilateral cleft palate in children 18 years and below which were repaired using the VLT with and without lateral alveolar incision in our centre between January 2013 and December 2018. Outcome parameters obtained included duration of surgery, blood loss, complication and fistula rates. Data was analyzed using SPSS 21. Statistical significance was set at p<0.05.

Results: Eighty four patients were included in the study; 36 were in the test group and 48 were in the control group. There was no significant difference in the age, weight and gender of the two groups. The duration of surgery was significantly shorter in the test group and fistula and complication rate was less.

Conclusions:This study has demonstrated that comparable, if not better results can be achieved in well selected patients with unilateral isolated cleft palate using only dissection along the margin of the cleft. This new technique reduces the duration of surgery and anaesthesia and may reduce blood loss and complications.

 

References

Stein MJ, Zhang Z, Fell M, Mercer N, Malic C. Determining postoperative outcomes after cleft palate repair: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2019;72(1):85-91.

Lindsay WK, Witzel MA. Cleft palate repair: Von Langenbeck Technique. In: Bardach J, Morris HL, editors. Multidisciplinary management of cleft lip and palate. Philadelphia: W.B. Saunders Company; 1990: 303.

Gatti GL, Freda N, Giacomina A, Montemagni M, Sisti A. Cleft lip and palate repair. J Craniofac Surg. 2017;28(8):1918-24.

Akinmoladun V, Ademola S, Olusanya A. Management of cleft lip and palate in Nigeria: A survey. Niger J Clin Pract. 2017;20(11):1355-9.

Olasoji HO, Hassan A, Adeyemo WL. Survey of management of children with cleft lip and palate in teaching and specialist hospitals in Nigeria. Cleft Palate Craniofac J. 2011;48(2):150-5.

Wallace AF. A history of the repair of cleft lip and palate in Britain before World War II. Ann Plast Surg. 1987;19:266–75.

Lu Y, Shi B, Wang Z, Zhan X. Study on wound healing after Sommerlad technique repair of isolated cleft palate Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014;28(7):869-72.

Hortis-Dzierzbicka M, Radkowska E, Stecko E, Dudzinski L, Fudalej PS. Speech outcome in complete unilateral cleft lip and palate - a comparison of three methods of the hard palate closure. J Oral Rehabil. 2014;41(11):809-15.

Lv C, Cai C, Tao R, Song JX, Zhang JD. Primary repair of broad bilateral complete cleft palate with hard palate rotation flap. J Craniofac Surg. 2013;24(3):809-11.

Lee YH, Liao YF. Hard palate-repair technique and facial growth in patients with cleft lip and palate: a systematic review.Br J Oral Maxillofac Surg. 2013;51(8):851-7.

Tan WQ, Xu JH, Yao JM. The single Z-plasty for cleft palate repair: a preliminary report. Cleft Palate Craniofac J. 2012;49(5):635-9.

Williams WN, Seagle MB, Pegoraro-Krook MI, Souza TV, Garla L, Silva ML,et al. Prospective clinical trial comparing outcome measures between Furlow and von Langenbeck Palatoplasties for UCLP. Ann Plast Surg. 2011;66(2):154-63.

Moores C, Shah A, Steinbacher DM. Cleft palate repair using a double opposing z-plasty. J Craniofac Surg. 2016;27(5):444-5.

Louis M, Dickey RM, Hollier LH Jr. Smile Train: Making the grade in global cleft care. Craniomaxillofac Trauma Reconstr. 2018;11(1):1-5.

Furlow LT, Jr Cleft palate repair by double opposing Z-plasty. Plast Recostr Surg. 1986;78:724–38.

Senders CW, Fung M. Factors influencing palatoplasty and pharyngeal flap surgery. Arch Otolaryngol Head Neck Surg. 1991;117:542–5.

Maluf I Jr, Doro U, Fuchs T, dos Santos DE, dos Santos SF, da Silva Freitas R, et al. Evaluation of maxillary growth: is there any difference using relief incision during palatoplasty? J Craniofac Surg. 2014;25(4):1563.

Odom EB, Woo AS, Mendonca DA, Huebener DV, Nissen RJ, Skolnick GB, et al. Long-Term Incisal Relationships After Palatoplasty in Patients With Isolated Cleft Palate. J Craniofac Surg. 2016;27(4):867-70.

Agrawal K. Cleft palate repair techniques. Indian J Plast Surg 2009;42:S102-S109.

Phua YS, Chalain T. Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990 and 2004. The Cleft Palate- Craniofacial J. 2008;1545-69.

de Agostino Biella Passos V, de Carvalho Carrara CF, da Silva Dalben G, Costa B, Gomide MR. Prevalence, cause, and location of palatal fistula in operated complete unilateral cleft lip and palate: retrospective study. Cleft Palate Craniofac J. 2014;51(2):158-64.

Leclerc JE, Godbout A, Arteau-Gauthier I, Lacour S, Abel K, McConnell EM. We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients. Laryngoscope. 2014;124(2):561-9.

Téblick S, Ruymaekers M, Van de Casteele E, Nadjmi N. Effect of cleft palate closure technique on speech and middle ear outcome: A systematic review. J Oral Maxillofac Surg. 2019;77(2):405.

Antonelli PJ, Jorge JC, Feniman MR, Piazentin-Penna SH, Dutka-Souza JC, Seagle MB. Otologic and audiologic outcomes with the Furlow and von Langenbeck with intravelar veloplasty palatoplasties in unilateral cleft lip and palate. Cleft Palate Craniofac J. 2011;48(4):412-8.

Downloads

Published

2019-06-29

Issue

Section

Original Research Articles