National University of Colombia, Colombia
Background: Despite the lack of consensus regarding the treatment of labio-palatal clefts, each treatment protocol is the expression of an individual perspective that accumulates the experience of each multidisciplinary group, which all pursue the same goal: to achieve adequate language development with the lowest possible impact on facial growth. The purpose of this work was to show a new protocol of management. This was designed because the authors are convinced that the extensive and aggressive dissections on the palatine mucoperiosteum have deleterious effects on the midface growth. It favors the limited dissection of palate segments, exploiting vomer versatility, designing flaps according to the requirements of each type of cleft (Veau’s classification), (17) and routinely associated to a Furlow-type veloplasty. Methods: Seven hundred and fifty patients with cleft palate (Veau type II, III, and IV) were treated between 1990 and 2016 at “Fundación Hospital de la Misericordia”. The authors combined various techniques, in accordance with the requirements of each type of cleft palate. All surgeries were performed by one of two surgeons (JRGD or OJGD). Results: This protocol has the advantage of using limited dissections on the mucoperiosteum, which preserves the major and minor vascular pedicles, and also dramatically restricts the use of relaxation incisions adjacent to the alveolar rims. No cases of necrosis of the vomer were observed, as it is not completely denuded in the process (only the portion of mucosa necessary to achieve closure of the nasal plane is denuded). In the experience of the authors, through use of this technique, an incidence of 10% union fistulas was obtained, and only 10% of these required surgical treatment. A pharyngoplasty was required in 12% of the cases. Conclusion: Modifications are presented in the design and dissection of Vomer flaps, so as to use the largest amount of mucosal tissue available, thus facilitating closure of the different clefts, particularly in Veau Group III clefts.