Sunday, December 28, 2014

Training sessions: minimal incision palatoplasty with levator repositioning

2012 minimal incision palatoplasty with levator repositioning

In this method, I use a relatively bloodless
minimal incision method using 1:500,000
saline adrenaline hyrdro dissection by mixing
1mg adrenaline in 500 ml saline
Starting from the medial minimal incisions,using
fine curved sharp scissors,I dissect the
levators from their insertion on the palatal
aponeurosis / bony hard palate and
reposition the muscles in a transverse
position;the uvular is 2/3 retro positioned
I also add a small button hole incision over the
hamulus to fracture the bone,incise the
tensor and medialize the muscles.
The surgery takes 20-25 minutes and is very safe
The complete palate is closed in 2 stages- stage
one includes soft palate closure with levator
repositioning;the stage 2 minimal incision
palatoplasty is done after 6 months to a year
Ongoing study:over 270 cases,no intra/ post op
bleeds or hypoxia in any
• The levator repositioning improves
speech
• The nasal flaps are best approached
from the lateral side to prevent
tearing
• It is easier to raise the mucoperiosteal
flaps from the mid palate where the
tissue is loose and less vascular
• Palatal fistula is usually due to wrong
technqiue and too much tension on
the flaps and ,wound infection.

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