Comparative Outcomes of Conventional Bardach Two-Flap Palatoplasty Versus Modified Alveolar Ridge/Crevicular Incision Technique in Isolated Cleft Palate Repair: A Prospective Observational Study

Background Isolated cleft palate (CP) disrupts the feeding, speech, and social development of young children. Standard Bardach two-flap palatoplasty effectively closes the defect but can leave large areas of exposed bone along the sides, particularly in wider clefts. The exposed bone may lead to scar formation and restricted jaw growth. A modified version of the two-flap technique uses incisions along the alveolar ridge or within the gum crevice to mobilize tissue, minimize exposed bone, and achieve closure without tension. This study compared the operative efficiency, postoperative complications, and functional outcomes between conventional and modified techniques in pediatric patients with isolated CP. Methodology This prospective, observational study was conducted over a period of 24 months. In total, 24 children aged 12-24 months with Veau I/II isolated CP were divided into the following two groups (n = 12 each): Group A underwent conventional Bardach two-flap palatoplasty, and Group B underwent the modified technique with alveolar ridge/crevicular incisions. All surgeries were performed under general anesthesia with intravelar veloplasty and layered closure using 4-0 Vicryl sutures. The outcomes assessed included operative time, tension-free closure, fistula formation (Pittsburgh classification), nasal regurgitation, uvular morphology, and deciduous teeth eruption patterns. Follow-up was extended to 18 months. Data were analyzed using Fisher's exact test and the independent t-test (p < 0.05). Results Demographic characteristics were comparable between the groups. The mean operative time was 135 minutes (conventional) versus 141.67 minutes (modified) (p = 0.387). Tension-free closure was achieved in eight (66.67%) conventional and 12 (100%) modified cases (p = 0.121). No fistulas or nasal regurgitations occurred in either group. Two (16.67%) patients per group had a minor delay in deciduous tooth eruption (p = 1.0). Uvular morphology was satisfactory in six (50%) conventional and eight (66.67%) modified cases (p = 0.558). All differences were not statistically significant. Conclusions Both conventional and modified two-flap palatoplasty techniques yielded equivalent surgical and functional outcomes, with minimal morbidity in Veau I/II isolated CP repair. The modified approach tended toward better mobilization and tension-free closure in wider defects without increasing the operative time or complications. Larger randomized trials with long-term cephalometric and speech evaluations are recommended to confirm these clinical benefits.