<< Back to the abstract archive
Intraoperative salvage after greater palatine pedicle transection during cleft palatoplasty
Ali M. Ayyash, MPH; Luke A. Dvoracek, MD; Jonathan Lee, MD, MPH; Joseph E. Losee, MD; Jesse A. Goldstein, MD
University of Pittsburgh
2018-02-15
Presenter: Ali Maher Ayyash
Affidavit:
Ali M. Ayyash
Director Name: Dr. Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
INTRODUCTION: Several adjunctive procedures have gained traction to aid cleft surgeons in repairing challenging palatal clefts. Buccal fat flaps and buccal myomucousal flaps may be particularly helpful in the setting of scarred tissue or vascular compromise. Here we describe the case of an intraoperative salvage using bilateral buccal fat flaps and a right buccal myomoucosal flap after a right greater palatine artery (GPA) transection during palatoplasty on a 14-month old female with a wide Veau-II cleft palate.
RESULTS: A Furlow palatoplasty was planned to address the soft palate and a Bardach unipedicled palatoplasty was planned to address the hard palate. As the right sided nasal myomucosal flap was raised, the greater palatine neurovascular bundle was inadvertently transected, devascularizing the right mucoperiosteal flap. After nasal lining closure, bilateral buccal fat flaps were advanced into the hard-soft palate junction. The intact, left sided mucoperiosteal island flap was advanced past the midline for further coverage of the anterior defect. A 4 by 2 cm right buccal myomucosal flap was elevated from the oral commissure. The buccal myomucosal flap was then fixated along the majority of the right junction of soft and hard palate with 4-0 vicryl suture. At 8-months of follow-up, the flaps appeared well healed with minimal scarring and no signs of pocketing or fistula.
DISCUSSION: This case describes the salvage of a cleft palate with bilateral buccal fat and unilateral buccal myomucousal flaps after inadvertent transection of the right GPA.
