Better Hearing Results in Cleft Palate Repaired by the Bone Flap Technique

Abstract

The presence of a conductive type of hearing loss in repaired and unre-paired cleft palate cases is well established in the literature (3, 4, 5). Reduced hearing sensitivity is usually brought about by certain specific medical conditions that primarily affect the middle ear area. These medi— cal conditions range from a fluid build-up in the middle ear (otitis media) to various degrees of retraction of the eardrum or bulging of the eardrum. The conditions are usually bilateral and equal in severity. An associated hearing loss can also be bilateral and equal in the degree of impairment. The various medical conditions and associated hearing losses can frequently be found in noncleft palate cases as well. One of the most common reasons for the presence of the various medical conditions and a frequent decrease in hearing sensitivity may be that deficient structure and function of the tensor and levator muscles of the palate lead to abnormal occlusions of the eustachian tubes. The poor muscular control that often occurs With repaired and unrepaired cleft palate can have a long standing history in many cases. Many of the surgical techniques presently employed in the repair of cleft palates effect a desirable closure but do not maintain an effective muscle control for the proper function of the eustachian tubes. Preper closing of the eustachian tube is difficult and the consequent result can be the various medical problems and decreased hearing sensitivity that is so often as— sociated with cleft palate cases. In our opinion, the bone flap technique of surgical repair of cleft palates permits a greater control of eustachian tube closure (1, 2, 6). The technique permits important musculature to remain fairly intact, and better control and function of the tensor and levator muscles is assured. The ideal operative procedure for correcting cleft of the palate should be one that enables the surgeon to place the parts Whose development has been arrested into their normally intended positions, Without disturbing the attachments of the muscles of the palate, and With as few steps as pos—