Tragal cartilage augmentation in repair of cleft palate, a new technique and its clinical implications

• Published in: International journal of pediatric otorhinolaryngology 2010-08, Vol.74 (8), p.891-895
• Main Authors: Ezzat, W.F, Rabie, H, Tarabishi, M
• Format: Article
• Language: English
• Subjects: Cartilage - transplantation; Cartilage augmentation; Child; Child, Preschool; Cleft palate; Cleft Palate - diagnosis; Cleft Palate - surgery; Cohort Studies; Egypt; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Infant; Male; Otolaryngology; Palate, Hard - surgery; Palate, Soft - surgery; Pediatrics; Postoperative Complications - physiopathology; Reconstructive Surgical Procedures - methods; Risk Assessment; Time Factors; Tragal cartilage free graft; Treatment Outcome
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2010.05.006

Abstract Background Cleft palate is one of the most common congenital anomalies of the head and neck worldwide. In addition to the evident feeding and growth problems, patients are involved with and suffer from speech, hearing and dental problems. Many surgical techniques and modifications have been advocated to improve functional outcome and aesthetic results, aiming at normal speech, minimizing growth disturbances, and establishing a competent velopharyngeal sphincter. Despite the variety of techniques described for repair of the clefts, there is still a relatively high incidence of postoperative fistula reaching up to 35%. This is mainly related to type and degree of the defect, and type of surgical repair. Objectives To evaluate the efficacy of placement of tragal cartilage free graft between the oral and nasal mucosal layers of the neo-palate in improving success rates, and anatomical and functional outcomes in repair of cleft palate with reduction of the extent of dissection. Patients and methods Fourteen patients were managed by our technique, only in large cases minimal von Langenbeck lateral release incisions were made. In all cases a tragal cartilage graft was interpositioned and fixed to the muscle layer of the neo-palate, 2–3 extramucosal trans-muscle sutures were placed for 3–4 weeks if needed, and the patients were followed up for a minimum of 12 months during which functional and anatomical assessments were done. Results Results, including both anatomical and functional outcomes, were favorable with no gross failures, permanent significant fistula formations (one case with minor non-significant fistula), nor donor site co morbidities. Conclusion The use of tragal cartilage free graft to augment the area at the junction between the hard and soft palate appears to be a safe and effective method in repair of cleft palate that reduces the incidence of postoperative palatal fistulae, without donor site comorbidities.