This one is about: How Does Surgery Close the Palate?
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This sounds like kind of a stupid question, but the only stupid question is the one you don't ask... right?
How exactly is the palate closed during surgery? I realize there are probably different answers to this depending on the type and severity of cleft, but there are probably some basic techniques. How is the new hard palate formed? And what do they sew together?
In initial visits with our PS, he told us that we should only have to use materials from Amy's own mouth (i.e. no bone grafts) in order to close the hard and soft palate. I have had a lot of people ask me exactly how they will do the closure, but I just don't know.
We are having our next PS visit on Nov 18, and they will theoretically schedule the surgery at this meeting. I will definitely be asking him these questions, but if I can go in kind of knowing what answer to expect, I can probably ask more intelligent questions.
----- Various Responses -----
There is a wonderful Learning Channel film on this, if you can get a hold of it. It shows in graphic detail how it's done.
Basically, there are two sides - the oral side and the nasal side. The tissue is all there - more or less - but not currently attached.
The doctor will make incisions along the gum line and pull the tissue away from the bone there, freshen the edges of the cleft tissues, move the tissue down to create two large denuded triangular patches behind the teeth, and attach the tissue in the middle. The front then is often (not always) anchored to the front an the triangular patches heal over while the tissue move to the middle bonds and forms the hard palate. Often (again - not always) the resulting hard palate end up more flexible than a non-repaired hard palate. There are other techniques, but the one I described is most likely the one they will use. If your Dr. says he will be using a Furlow technique, disregard what I just said and ask your question again.
The Furlow is also called a "double reversing z-plasty". Two zig-zag repairs are done - one on the nasal side, then one on the oral side - overlapping each other and reversing the direction of the zig-zag. The result is a much longer, more flexible repair that is resistant to complete fistulae (a fistula that goes all the way through).
Regarding babies with Pierre Robin, another parent asks:
I was wondering how they do babies with Pierre Robin who usually have a wide cleft so there is very very little tissue on each side of the cleft.
A parent responds:
Pierce (Pierre Robin) had his repaired with the triangular patches. In PR kids with a very wide cleft they usually wait until the baby is slightly older (more tissue to work with) and the cleft may have diminished in width (Pierce's did by over half) due to the cartilage growing in the roof of the mouth. It doesn't seem possible but somehow the PS manage to close the cleft - miracles do happen. :)
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