Buccal Mucosa Graft for Cleft Palate Surgery

Background: Cleft palate repair aims at producing closure of the cleft with reasonable lengthy palate in order to have competent velopharyngeal closure. There are various procedures concentrate on the lengthening of the palate like: Veu Wardill and Kilner, Furlow double opposing Z-plasty, Mukherji bilateral mucosal cheek flap, and Kaplan unilateral mucosal cheek flap etc. Buccal mucosal flap for nasal layer combined with Z-Plasty in the oral layer of the soft palate is one of these procedure provide reasonable length for cleft palate repair. Objective: The aim of this study is to evaluate palatal lengthening by combination of unilateral retromolar buccal mucosal flap with Z-plasty and assessment of speech improvement. Patients and methods: A prospective study of 22 patients of non-syndromic cleft palate underwent palatoplasty by unilateral retromolar buccal mucosal flap combined with Z-plasty of the mucous membrane of the oral layer in period from December 2008 to September 2009. All patients evaluated regarding the type of the cleft by Veau’s classification, the length and the width of the cleft palate measured by using a ruler and the depth of eth nasopharynx (from the posterior margin of the soft palate to the posterior pharyngeal wall) also measured . Result: The most common type of the cleft was unilateral cleft lip and palate (50%). The mean age at repair was 18 months. All patients developed acceptable palatal length intra-operatively; the gain in length was ranged from 1.7-2.5cm the mean was (2.2cm). One patients developed oronasal fistula at the junction of soft and hard palate was. Conclusion: This technique was effective for lengthening the nasal as well as oral layer, also had advantage of achieving good muscular reconstruction.