Evidence-Based Practices in Cleft Palate Surgery | Journal CME Article-Journal CME Article: Evidence-Based Practices in Cleft Palate Surgery Article

Journal CME Article: Evidence-Based Practices in Cleft Palate Surgery Article

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The document provides a comprehensive overview of cleft palate, encompassing its embryological origins, prevalence, anatomy, surgical techniques, and associated perioperative care. Cleft palate affects 0.1 to 1.1 per 1000 births and can occur alone or with other congenital anomalies. The primary aim of surgical repair is to separate the oral and nasal cavities to improve feeding and speech and to prevent complications such as oronasal fistulas and velopharyngeal dysfunction.<br /><br />Key sections include:<br /><br /><strong>Anatomy and Classification:</strong> The cleft palate primarily involves the secondary palate, comprised of the hard and soft palate, with a structured classification system like the Veau classification used to denote severity and anatomy involved.<br /><br /><strong>Embryology:</strong> The formation of the palate involves complex embryological processes that, when disrupted, lead to clefting. This disorder is associated with disruption of muscle alignment in the palate, significantly impacting function.<br /><br /><strong>Surgical Techniques:</strong> Various techniques are used for cleft palate repair, including von Langenbeck palatoplasty, Veau-Wardill-Kilner pushback, and Bardach’s two-flap palatoplasty, each with distinct methods and suitable indications. The Furlow palatoplasty is a prominent technique for soft palate repair, aiming to restore muscle functionality and improve speech outcomes.<br /><br /><strong>Timing and Management:</strong> Optimal timing for surgery is often between 11 to 12 months to balance growth with speech outcomes. Management includes prenatal diagnostics and ongoing clinical surveillance until the child reaches skeletal maturity.<br /><br /><strong>Complications and Adjunct Procedures:</strong> Postoperative complications may include airway compromise, fistula formation, and speech impediments, with various adjunct procedures like the buccal fat flap used to improve outcomes.<br /><br />Overall, the article emphasizes a multidisciplinary approach, personalized surgical planning, and preoperative optimization to address both the functional and aesthetic outcomes in cleft palate repair.

Keywords

cleft palate

embryology

surgical techniques

Veau classification

von Langenbeck palatoplasty

Furlow palatoplasty

perioperative care

oronasal fistulas

velopharyngeal dysfunction

multidisciplinary approach