Primary von Langenbeck Palatoplasty with Levator Reconstruction: Rationale and Technique

Abstract

In the preceding article, patients undergoing von Langenbeck palatoplasty without reconstruction of the levator veli palatini mus— cles were compared to patients undergoing the identical procedure, but with intravelar veloplasty. Palatoplasty included repair of both hard and soft palate, tension-free approximation of mucoperiosteal and soft palate flaps, and everting suture of nasal mucous membrane and oral mucous membrane from the anterior extent of the palate cleft t0 the tip of the uvula. No attempt was made to repair an alveolar cleft, if present. The authors concluded that intravelar veloplasty was of significant value in providing velopharyngeal competency, and in this companion article the rationale and technical details are presented. Grabb (1971) has given as reasons for closing a cleft palate the provision of a mechanism for normal speech, hearing, dental occlusion, and swallowing and the separation of the oral and nasal cavities. Implicit in the attainment of these objectives in palate closure is the requirement for avoiding interference with facial bone growth. Although there seems to be general agreement on the reasons for cleft palate closure, there is very little agreement on almost all other aspects of cleft palate surgery. There is controversy about the Dr. Trier is affiliated with the Division