The technique of muscle repair in the cleft soft palate

The Importance of Radical Intravelar Veloplasty during Two-Flap Palatoplasty

“…The muscle should therefore be released fully-indeed, skeletonizing the muscle-to eliminate any residual restriction of mobility imparted by the tensor veli palatine aponeurosis. Sommerlad 8,25,26 and Cutting et al 7 described a radical intravelar veloplasty in which the levator muscle is dissected from the palate, oral, and nasal lining and retropositioned in a more transverse orientation. Although the idea of the two-flap palatoplasty technique is not to lengthen the palate as in the V-Y pushback, Bae et al 35 demonstrated that retropositioning of the velar muscles in itself allows for some lengthening of the soft palate.…”

“…We hypothesized that to improve our functional outcomes, a more extensive dissection and retropositioning of the levator muscle is necessary. Radical intravelar veloplasty, described by Cutting et al 7 and Sommerlad,8 has been demonstrated to decrease the need for secondary palate surgery to levels below 10 percent, and for this reason we decided to incorporate it as part of the surgical treatment of our cleft palate patients. Consequently, the purpose of this article is to report our 10-year experience using the twoflap palatoplasty technique with and without radical intravelar veloplasty, with special emphasis on the fistula rate and speech outcome.…”

Evaluation of Two Palate Repair Techniques for the Surgical Management of Velopharyngeal Insufficiency

“…Following radical levator dissection, rather than the direct reapproximation described classically, 12,13 both ends are overlapped to create a tight muscular sling. The nasal mucosa is closed longitudinally and the oral mucosa is repaired by means of a single Z-plasty to achieve palatal lengthening.…”

Evidence-Based Medicine

“…Restoration of the normal muscular anatomy was first described by Braithwaite 8 in 1964 and subsequently radically modified in 1970 by Kriens,9 who coined the term "intravelar veloplasty." Again, there are many commonly used techniques for recreating the levator sling, including the double-opposing Z-plasty 10,11 and those described by both Cutting et al 12 and Sommerlad et al 13,14 Regardless of the technique used, the goals of cleft palate repair remain as follows: (1) lengthen the palate to minimize the incidence of postoperative velopharyngeal insufficiency and promote proper speech development, (2) minimize maxillary and alveolar growth disturbances, and (3) prevent fistula formation.…”