This document discusses classifications and repair techniques for cleft palate. It describes three main groups of cleft palate classifications based on the location and extent of the cleft. For repair, it recommends timing of 12-18 months when babbling occurs. Key principles of repair include closure of the defect, reconstruction of the muscle sling, and retropositioning of the soft palate. Several surgical techniques are outlined, including von Langenbeck's, Veau-Wardill-Kilner, Bardach's two-flap, and Furlow Double Opposing Z-Plasty methods. Post-operative care and potential complications are also reviewed.

1. Cleft palate

2. CLASSIFICATION

3. Davis and Ritchie
• Group I - Clefts anterior to the alveolus
(unilateral, median, or bilateral cleft lip)
• Group II - Postalveolar clefts (cleft palate
alone, soft palate alone, soft palate and hard
palate, or submucous cleft)
• Group III: Alveolar process cleft (any cleft
involving the alveolar process)

4. Veau

5. Kernahan
and Stark
symbolic
classification

6. LAHSHAL classification

7. International Confederation of Plastic
and Reconstructive Surgery
classification
• Group I – Defects of the lip or alveolus
• Group II – Clefts of the secondary palate (hard
palate, soft palate, or both)
• Group III – Any combination of clefts involving
the primary and secondary palate

9. Repair

10. Timing
• 12-18 months
• Babbling as indicator

11. Principles
• Closure of the defect.
• Correction of the abnormal position of the
muscles of the soft palate, especially Levator
Palati.
• Reconstruction of the muscle sling.
• Retropositioning of the soft palate so much so
that during speech the posterior part of the
soft palate comes in contact with the
posterior pharyngeal wall during speech.

12. • Minimal or no raw area should be left on the
nasal side or the oral surface.
• Tension-free suturing.
• Two-layer closure in the hard palate region
and a three-layer closure of the soft palate.

13. Pre op
• Pre operative evaluation
• Position: supine with neck extended
• Mouth gags: Kilner-Dott and Dingman mouth
gags
• Adrenaline saline solution in dilution of
1:200,000

14. Surgical techniques
• von Langenbeck's bipedicle flap technique
• Veau-Wardill-Kilner Pushback technique
• Bardach's two-flap technique
• Furlow Double opposing Z-Plasty

15. • Two-stage palatal repair
• Hole in one repair
• Raw area free palatoplasty
• Alveolar extension palatoplasty (AEP)
• Primary pharyngeal flap
• Intravelar veloplasty
• Vomer flap
• Buccal myomucosal flap

16. von Langenbeck technique

17. • still used in isolated cleft palate repair

18. Veau-Wardill-Kilner Palatoplasty
• leaves an extensive raw area anteriorly and
laterally along alveolar margin with exposed
bare membranous bone.
• causes shortening of the palate and results in
velopharyngeal incompetence.
• alveolar arch deformity and dental
malalignment

20. Bardach two-flap plasty
• Free mucoperiosteal flaps
• based on the greater palatine vessels
• reconstruction of the muscle sling is
performed as in intravelar veloplasty

22. Furlow Double Opposing Z-Plasty
• double reverse Z-plasty for the oral and nasal
surfaces
• effective lengthening of the soft palate
• suture line is horizontal
• good overlap of the levator muscle

24. Two-stage Palatoplasty
• soft palate was repaired along with the lip at
around four to six months of age and the hard
palate was repaired at age of 10-12 years
• later reduced to four to five years
• Early palatal surgical intervention causes
maxillary hypoplasia
• speech result was compromised

25. Hole in one repair (One-stage cleft lip
and palate repair)
• in children above 10 months of age
• popularised by Prof. K.S. Goleria
• ‘hole in one’ is borrowed from the Game of
Golf

26. Raw area free palatoplasty
• two-flap palatoplasty.
• palatal lengthening is performed by the nasal
mucosa back-cut
• raw area is covered with a local flap like the
vomer flap or buccal mucosal flap.
• On the oral side too an attempt is made to
suture all the lateral incisions
• Healing with primary intention

27. Variations
• Bumsted's two-layer closure of palate in very
wide cleft palate
• Widmaier-Perko Palatoplasty
• Supraperiosteal dissection of flap in the region
of hard palate instead of mucoperiosteal flap.
(to minimize the maxillary hypoplasia)

28. • Osada's two-stage palatoplasty
• Frolova primary palatoplasty technique
• Anterior mucoperiosteal hinge for nasal lining
in partial cleft palate
• Marginal musculo-mucosal flap

29. Post op
• Early feeding
• Arm restraint
• Analgesics

30. Complications

31. Immediate complications
• Haemorrhage
• Respiratory obstruction
• Hanging Palate
• Dehiscence of the repair
• Oronasal fistula formation

32. Late complications
• Bifid uvula
• Velopharyngeal Incompetence
• Abnormal speech
• Maxillary hypoplasia
• Dental malpositioning and malalignment
• Otitis media