Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
Cleft palate repair should be done with minimal tension across the suture line in order to avoid the development of palatal fistula. Fracture of the pterygoid hamulus is routinely done by many surgeons during cleft palate surgery to facilitate soft tissue approximation.
OBJECTIVE:
To demonstrate the actual need for fracturing the pterygoid hamulus in palatoplasty.
PATIENTS AND METHODS:
Seventy-one cleft palate patients were studied, their ages ranged between 16 months and 14 years .In all of them surgical repair was done by Veau-Wardill- Kilner operation without fracturing of the pterygoid hamulus .Dissection of the mucoperiosteal flaps from the underlying muscles was done to overcome the tension and the clefts were closed in layers . The patients were observed for the ease of the closure during surgery and the development of fistulas postoperatively.
RESULTS:
Closure can be obtained with minimal tension without fracturing the pterygoid hamulus even in wide clefts if the flaps are properly released from the underlying muscular attachment. Postoperatively three cases developed postoperative bleeding and 2 cases had palatal fistulas.
CONCLUSION:
Fracturing of the pterygoid hamulus is not indicated in repair of narrow to moderate clefts. In wide clefts successful closure can be obtained without fracturing if adequate release of the flaps from the muscles is done, otherwise fracturing might be justifiable to reduce the tension across the suture line.