Preliminary Evaluation of the Island Flap in Cleft Palate Repair

Abstract

One of the prime requisites for good speech after cleft palate repair is the attainment of adequate palate length and mobility, thus resulting in velopharyngeal closure. The standard pushback palate procedures necessarily leave a large raw area on the nasal side which must heal by secondary intention and probable scar contraction. This may contribute to eventual shortening with decreased mobility of the repaired palate and poor speech. Efforts to cover this raw area have included the skin graft technique of Baxter (1) and Dorrance and Bransfield (3), the nasal mucosal flaps devised by Cronin (2), and more recently, the island pedicle flap originally described by Millard (7—9). The island flap procedure utilizes an island of anterior mucoperiosteal tissue based on the greater palatine neurovascular bundle. By turning this island over to cover the raw nasal side (resulting from the push-back), a one-stage repair is accomplished (Figure 1). As with any type of palate closure, the final evaluation must await the analysis of speech in the long term follow—ups. Because speech development is a changing dynamic process maturing with the growing child, many years and a significant number of well-studied cases are necessary for meaningful conclusions. With this in mind, longitudinal studies are carried out on all of our island flap repairs, utilizing a number of methods to evaluate postoperative results. Direct inspection of the palate is used to give information on the integrity, mobility, and symmetry of the closure. Lateral X rays and cinefluorography provide information on the range of palatal motion and the size of the velopharyngeal gap. Articulation tests, airflow manometry, and electromyography are used on the older and more cooperative patient. We have also included the operative and post-operative serial measurements of the distance between wire markers placed to measure the width of the island flap. These markers are The authors are affiliated with the