Tuesday, December 30, 2014

Training sessions: anatomical considerations in cleft palate surgery





1.The levator sling is created : the muscles are detached from their abnormal insertions on the palatal bone and retro positioned to make them meet in the midline at a distance of 7-10mm
2.A button hole incision below the middle of the maxillary tuberosity identifies the hamulus which is fractured to medialize the muscle complex

3.The tensor tendon is incised as it hooks around the hamulus process of the sphenoid bone
4.The palatal aponeurosis formed by the levator and tensor insert on the posterior surface of the palatal bone;this is incised with a sharp blade to release the muscle fully
5. the elevation of hard palate mucoperiosteum is made in the middle zone near the palatal rugae where the attachment is looser.
The neuro vascular bundle lies a few mm medial to the 2nd molar –care is taken to  dissect this structure so that the flap can be moved easily to the midline
* submucus cleft palate may be diagnosed by bifid uvula,zona pellucida due to muscle deficiency in the midline and osseous notch on the hard palate

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