Quantitative and Qualitative Assessment of Medial Osteotomy of the Greater Palatine Foramen in Wide Cleft Palate Repair

Abstract

Background: Repairing of a wide cleft palate faces with several problems, e.g. medialization of palatal flaps, lack of tissue for repair, and fistula formation. We aimed at quantitative and qualitative evaluation of medial osteotomy of the greater palatine foramen for patients with wide cleft palate and its postoperative outcomes. Methods: Eight patients 4 males, 4 females with wide cleft palate and the median age of 1.5 year were operated using medial osteotomy of the greater palatine foramen from 2018-2020. In this technique, the osteotomy was carried in the outlet of vascular pedicle medially and posteriorly. This led to more degrees of freedom for the vascular pedicle and a palatoplasty without tension through mucoperiosteal flap movement toward the medial direction. Results: After osteotomy and repairing for 8 patients (16 flaps), the mean (SD) length of mucoperiosteal flap pedicle was significantly increased from 2.78 mm to 6.09 mm (P<0.001). All patients were successfully repaired with no major complications, and none of them required any secondary repair. Three weeks postoperatively, all patients showed normal feeding, normal nasal resonance of speech with normal palatal mobility. Conclusion: Osteotomy of the greater palatine foramen for the closure of wide palatal clefts showed a good efficiency, quantitatively and qualitatively. The mean length of mucoperiosteal pedicle increased by 3.22 mm (6.44 mm for bilateral) after repairing, which helps to more freely medial movement of the palatal flap and lesser tension across its closure. All patients were successfully improved without any major complications.