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The aim of this study was to evaluate wound healing clinically and histologically in beagle dogs after palatal repair during growth by the partially split flap technique and the von Langenbeck technique. A standardised soft tissue defect was created in the medial region of the palate. The partially split flap technique was performed in 14 dogs (age...
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Context 1
... the dogs in which palatal repair by von Langenbeck's method was simulated, relaxation incisions as far as the bone were made on both sides of the palate adjacent to the posterior teeth (Fig. 2). The remaining palatal mucoperiosteum was raised from the underlying bone with a small raspatory. The major palatine neurovascular bundle was not dam-aged during the operation. The soft tissue defect in the midline was closed and sutured in one layer with 4/0 polyglactin 910, leaving two areas of denuded bone adjacent to the ...
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In Nighantu many herbs are described for the management of wounds. Among these some single herb and in combinations are being tried in clinical practices and shown good healing activity. From ancient time to modern era healing is need to human being. For this many herbs have been experimented, documented and this process will be continuing till fur...
Objective- To present a new technique of suturing fresh massive wounds with skin flap in equine regardless of the flap direction and/or location.Design- Experimental in vivo study and clinical trial.Animals- Nine healthy donkeys for experimental study and 28 horses with different injuries that varied in shape and location for clinical trial.Procedu...
Citations
... Maxillofacial growth was reported to be inhibited following V-Y pushback and von Langenbeck approaches [14,15], and the disruption of potential growth is mostly attributed to the denuded bone as resulting of relaxing incisions left for secondary intent healing [7,[16][17][18][19] Numerous animal studies have shown that denudating the palatal bone by the relaxing incision impairs maxillary growth. Techniques without relaxing incisions have less potential to affect maxillary growth adversely when compared with other techniques with relaxing incisions [20][21][22][23]. Maxillary dysgenesis is thought to be influenced by scar tissue that forms in the denuded bone region following palate formation. ...
Objective
To assess the maxillofacial growth of patients with isolated cleft palate following the Sommerlad-Furlow modified technique and compare it with the effect of the Sommerlad technique.
Study design
A Retrospective Cohort Study.
Methods
A total of 90 participants, 60 patients with non-syndromic isolated soft and hard cleft palate (ISHCP) underwent primary palatoplasty without relaxing incision (30 patients received the Sommerlad-Furlow modified (S-F) technique and 30 received Sommerlad (S) technique). While the other 30 were healthy noncleft participants with skeletal class I pattern (C group). All participants had lateral cephalometric radiographs at least 5 years old age. All the study variables were measured by using stable landmarks, including 11 linear and 9 angular variants.
Results
The means age at collection of cephalograms were 6.03 ± 0.80 (5–7 yrs) in the S group, 5.96 ± 0.76 (5–7 yrs) in the S-F group, and 5.91 ± 0.87 (5–7 yrs) in the C group. Regarding cranial base, the results showed that there were no statistically significant differences between the three groups in S–N and S–N-Ba. The S group had a significantly shortest S-Ba than the S-F & C groups ( P = 0.01), but there was no statistically significant difference between S-F and C groups ( P = 0.80). Regarding skeletal maxillary growth, the S group had significantly shorter Co-A, S- PM and significantly less SNA angle than the C group ( P = < 0.01). While there was no significant difference between S-F & C groups ( P = 0.42). The S group had significantly more MP-SN inclination than the C group ( P = < 0.01). Regarding skeletal mandibular growth, there were no statistically significant differences in all linear and angular mandibular measurements between the three groups, except Co-Gn of the S group had a significantly shorter length than the C group ( P = 0.05). Regarding intermaxillary relation, the S-F group had no significant differences in Co-Gn—Co-A and ANB as compared with the C group. The S group had significantly less ANB angle than S-F & C groups ( P = 0.01 & P = < 0.01). In addition, there were no significant differences in all angular occlusal measurements between the three groups.
Conclusion
As a preliminary report, Sommerlad-Furlow modified technique showed that maxillary positioning in the face tended to be better, and the intermaxillary relationship was more satisfactory than that in Sommerlad technique when compared them in healthy noncleft participants.
... Numerous experimental studies have provided compelling evidence indicating that maxillary growth is adversely affected when the palatal bone is surgically removed using a relaxing incision. Techniques that involve minimal areas of denuded palatal bone are less likely to have negative effects on the maxillary growth when compared to other techniques with relaxing incisions [14][15][16]. ...
Objective
To estimate the impact of relaxing incisions on maxillofacial growth following Sommerlad-Furlow modified technique in patients with isolated cleft palate.
Study design
A Retrospective Cohort Study.
Methods
A total of 90 participants, 60 patients with non-syndromic isolated soft and hard cleft palate underwent primary palatoplasty (30 patients received the Sommerlad-Furlow modified technique without relaxing incision (S.F −RI group), and 30 received Sommerlad-Furlow modified technique with relaxing (S.F +RI group) with no significant difference found between them regarding the cleft type, cleft width, and age at repair. While the other 30 were healthy noncleft participants with skeletal class I pattern as a Control group. The control group (C group) was matched with the patient groups in number, age, and sex. All participants had lateral cephalometric radiographs at least 5 years old age. The lateral cephalometric radiographs were taken with the same equipment by the same experienced radiologist while the participants were in centric occlusion and a standardized upright position, with the transporionic axis and Frankfort horizontal plane parallel to the surface of the floor. A well-trained assessor (S. Elayah) used DOLPHIN Imaging Software to trace twice to eliminate measurement errors. All the study variables were measured using stable landmarks, including 12 linear and 10 angular variants.
Results
The mean age at collection of cephalograms was 6.03 ± 0.80 in the S.F +RI group, 5.96 ± 0.76 in the S.F −RI group, and 5.91 ± 0.87 in the C group.
Regarding cranial base, the results showed no statistically significant differences between the three groups in S–N and S–N-Ba. While the S.F +R.I group had a significantly shortest S-Ba than the S.F −R.I & C groups ( P = 0.01 & P < 0.01), but there was no statistically significant difference between S.F −R.I & C groups ( P = 0.71).
Regarding the skeletal maxilla, there was no significant difference between the S.F +R.I and S.F −R.I groups in all linear measurements (N-ANS and S-PM) except Co-A, the S.F +R.I group had significantly shorter Co-A than the S.F −R.I & C groups ( P = < 0.01). While the angular measurement, S.F +R.I group had significantly less SNA angle than the S.F −R.I & C groups ( P = < 0.01).
Regarding mandibular bone, there were no statistically significant differences in all linear and angular mandibular measurements between the S.F +R.I and S.F −R.I. groups.
Regarding intermaxillary relation, the S.F +R.I group had significant differences in Co-Gn—Co-A and ANB compared to the S.F −R.I & C groups ( P = < 0.01). While there was no statistically significant difference in PP-MP between the three groups.
Conclusion
As a preliminary report, the Sommerlad-Furlow modified technique without relaxing incisions was found to have a good maxillary positioning in the face and a satisfactory intermaxillary relationship compared to the Sommerlad-Furlow modified technique with relaxing incisions.
... 91,92 Early studies evaluated the palatal wound healing after excisional biopsies including all the soft tissue to the level of the palatal bone. 76,77,[93][94][95] Nevertheless, the current harvesting techniques do not involve secondary intention healing with denuded bone. In a recent study, the palatal wound healing after an excisional wound was found to progress from the most anterior and posterior wound borders, with minimal changes in the medio-lateral dimension at the early stage of healing. ...
Palatal‐tissue harvesting is a routinely performed procedure in periodontal and peri‐implant plastic surgery. Over the years, several surgical approaches have been attempted with the aim of obtaining autogenous soft‐tissue grafts while minimizing patient morbidity, which is considered the most common drawback of palatal harvesting. At the same time, treatment errors during the procedure may increase not only postoperative discomfort or pain but also the risk of developing other complications, such as injury to the greater palatine artery, prolonged bleeding, wound/flap sloughing, necrosis, infection, and inadequate graft size or quality. This chapter described treatment errors and complications of palatal harvesting techniques, together with approaches for reducing patient morbidity and accelerating donor site wound healing. The role of biologic agents, photobiomodulation therapy, local and systemic factors, and genes implicated in palatal wound healing are also discussed.
... The cats were typically evaluated by means of an awake oral examination 2 weeks post-surgery or in 4-8 weeks for the removal of the interquadrant splint and further dental treatment. Healing of the oral mucosa has been extensively studied in cleft palate models in dogs, where the midline defect healed quickly within 1 week by first intention after accurate apposition of the soft tissue edges, while the lateral incisions healed in ∼ 3-5 weeks by second intention with clot formation followed by granulation tissue, epithelialization, and scar formation (16)(17)(18). Mucoperiosteal defects of the hard palate of 1-cm diameter had almost completely healed by 7 days, but the center takes a few more days of healing (19). In this study, a mild inflammation was visible around the suture material when the follow-up was performed between 1 and 2 weeks as part of the normal healing process of the palatal mucoperiosteum or due to irritation and accumulation of debris around the sutures. ...
... The epithelialization over denuded bone progressed from the periphery toward the center of the defect, advancing faster from the lateral aspect of the defect than the medial aspect (14). The epithelium was thinner than in healthy palatal mucosa, and the firmly attached connective tissue lacked elastic fibers in the early weeks of healing (16,17,20). The soft palate healed quickly. ...
Acquired midline palate defects (PDE) affect the hard palate and/or soft palate, and result from trauma, commonly falling from a height or being hit by a motor vehicle. Additional life-threating injuries and costs associated with the treatment may delay the surgical treatment. This retrospective study describes signalment, cause, and extent of the PDE, and treatment in 25 cats. In addition, the outcome of the surgical repair is described in 19 (76%) cats. All defects were repaired within 5 days of the injury. Twenty (80%) cats were 4 years of age or younger. The most common rostral extent of the PDE was to the level of the third premolar tooth (n = 8; 32%), incisor teeth (n = 7; 28%), and fourth premolar tooth (n = 5; 20%). The soft palate laceration was present in all cases. Surgical therapy was successful in all cases with follow-up. The most common techniques used for the closure of the hard palate defect were bilateral pedicle flaps with lateral releasing incisions (n = 8; 32%), direct apposition of the oral mucosa (n = 7; 28%), bilateral pedicle flaps with lateral releasing incisions and interquadrant splinting (n = 5; 20%), and unilateral pedicle flap with one lateral releasing incision (n = 4; 16%). A tension-free closure by direct apposition of the edges was possible for the soft palate laceration. No oronasal fistulae were identified at follow-up. The only complication was malocclusion. The interquadrant splinting was most often used for PDE extending to the rostral portion of the hard palate (p < 0.05). The cats that suffered postoperative malocclusion were significantly more likely to have sustained temporomandibular joint injury, underwent CT scan, or had a feeding tube placed before discharge. The results of this retrospective study indicate that the early treatment (within 5 days) of the acquired longitudinal defects in the midline of the hard and soft palates is highly successful.
... [6][7][8][9] However, the creation of mucoperiosteal flaps in young animals is challenging for several reasons: (1) the reduced surgical space, the small amount of tissues available and their intrinsic friability; and (2), in an experimental study in dogs, flap creation has been suggested to hinder skull growth and result in maxillary deformity. [9][10][11][12] In the present case, the surgical technique was performed in a 4-month-old kitten, despite the increased risk of failure, at the owners' request due to the time-consuming nursing and poor quality of life of the kitten. Although the overall bone growth of the skull was not affected by surgery, relevant conclusions cannot be drawn based on this single case. ...
... (d) Nine months postoperatively no evolution of the ONFs is seen repair of CCPs. 3,8,[10][11][12][13][14][15][16] In dogs, some authors recommend performing the surgery at around 8 months of age. 8 However, performing a surgical repair either too early or too late (after 8 months) has been suggested to increase the risk of ONF formation. ...
Case summary
A 4-month-old female domestic shorthair kitten was presented for a congenital cleft palate causing nasal discharge and sneezing episodes. CT revealed a palatal bone defect involving 20% of the palatal area. Surgical correction of both the hard and soft palate defects was performed using the overlapping and medially positioned flap techniques, respectively. Complete healing of the wound and full resolution of the clinical signs occurred within a 1-month period. At 2 months postoperatively, two punctiform oronasal fistulae were observed rostrally without associated clinical signs. Control CT, performed 6 months postoperatively, revealed a 50% enlargement of the palatal bone defect. At 12 months postoperatively, the cat was still in good general condition without any clinical signs.
Relevance and novel information
To the best of our knowledge, this is the first report to describe the treatment of a congenital cleft palate in a kitten using the overlapping flap technique with a successful medium-term clinical outcome, despite the formation of two oronasal fistulae. This suggests that, as in dogs, full restoration of oronasal compartmentation is not mandatory to achieve functional outcome. The increase of the palatal bone defect over time may play a role in late oronasal fistulae formation and should be considered for surgical planning.
... Partial-thickness flaps are developed utilizing a scalpel blade. If this blade technique is not performed carefully it can lead to iatrogenic damage to the flap and/or blood supply (34)(35)(36). Blood supply preservation may be best achieved by elevating a full-thickness HPF to include the connective tissue, particularly in cases where the greater palatine artery is not incorporated in the flap (2,4,37). An expected complication of full-thickness flap transposition is maxillary and/or palatine bone exposure that requires healing by re-epithelization. ...
The objective of this retrospective pilot study was to describe potential risk factors for failure of hard palate mucoperiosteal flaps (HPF) transposed for closure of oronasal communication. Dogs (n = 28) with acquired oronasal communication defects were included in the study population. Functional success of an HPF was determined by visual inspection at the last examination and lack of clinical signs. Risk factors for HPF failure including age, sex, body weight, presence of neoplasia at the time of surgery, presence of neoplasia after surgery due to incomplete or narrow margins, use of CO2 laser, previous surgeries in the same location, HPF blood supply, size of the HPF as a percentage of the total area of the hard palate mucoperiosteum, and distance traveled by the apex of the HPF were evaluated using descriptive statistics and unadjusted logistic regression modeling. Seven out of 28 (25%) hard palate flap procedures resulted in persistent oronasal communication and were considered failures. Body weight (Median: 17 vs. 25 kg, OR = 0.94, 80% CI = 0.90, 0.99), presence of neoplasia at the time of surgery (86 vs. 57%, OR = 4.50, 80% CI = 1.01, 20.06), HPF area (Median: 0.49 vs. 0.41, OR = 84.40, 80% CI = 1.66, 4,298) and apex travel distance (Median: 2.06 vs. 0.67, OR = 5.15, 80% CI = 2.14, 12.38) were associated with flap failure. Within this sample, the presence of neoplasia at the time of initial surgery, increasing the area of the HPF, and distance traveled by the HPF apex were associated with a greater odds of HPF failure. Further studies with larger sample sizes are needed to confirm repeatability of these results. HPFs remain a viable surgical option for closure of oronasal communication. Careful surgical planning, strict adherence to surgical principles, and awareness of anatomical limitations can increase the likelihood of success.
... One major distinction between the surgical procedures is different timing and staging of hard and soft palate repair. One view suggests that hard palate surgery represents a greater threat to growth than soft palate surgery, thus protocols that delay hard palate closure and/or minimise releasing incisions and mobilisation of mucoperiosteal flaps are preferable [11]. In two-stage repair, repair of the hard palate is delayed for several months or years until spontaneous reduction in the size of the residual cleft has occurred after closure of the soft palate. ...
Background and aim: Good dentofacial growth is a major goal in the treatment of unilateral cleft lip and palate (UCLP). The aim was to evaluate dental arch relationships at age 5 years after four different protocols of primary surgery for UCLP.
Design: Three parallel randomised clinical trials were undertaken as an international multi-centre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK.
Methods: Three different surgical procedures for primary palatal repair (Arms B, C, D) were tested against a common procedure (Arm A) in the total cohort of 448 children born with non-syndromic UCLP. Study models of 418 patients (273 boys) at the mean age of 5.1 years (range = 4.8–7.0) were available. Dental arch relationships were assessed using the 5-year index by a blinded panel of 16 orthodontists. Kappa statistics were calculated to assess reliability. The trials were tested statistically with t- and Chi-square tests.
Results: Good-to-very good levels of intra- and interrater reliability were obtained (0.71–0.94 and 0.70–0.87). Comparisons within each trial showed no statistically significant differences in the mean 5-year index scores or their distributions between the common method and the local team protocol. The mean index scores varied from 2.52 (Trial 2, Arm C) to 2.94 (Trial 3, Arm D).
Conclusion: The results of the three trials do not provide statistical evidence that one technique is better than the others. Further analysis of the possible influence of individual surgical skill and learning curve are being pursued in this dataset.
Trial registration: ISRCTN29932826.
... Healing of denuded palatal bone by granulation typically occurs uneventfully $3 weeks later 1,2,6,7 ; this is in contrast with non-completely denuded palatal bone which takes $2 weeks to heal after harvesting flaps. 29 Additionally, it is believed that achieving complete closure of denuded bone reduces postoperative complications. 3 In the dogs we describe, all persistent palatal defects and surgical failure occurred only in dogs in which denuded palatal bone was left to heal by granulation; this supports the suggestion that achieving complete coverage of exposed bony structures during surgery decreases the rate of postoperative complications. ...
To report a staged approach that includes selective dental extractions before definitive double-layer hard palate defect closure in dogs.
Retrospective case series.
Dogs (n = 6) with a palatal defect.
Dogs had selective maxillary teeth extractions 4-8 weeks before definitive hard palate defect repair by double-layer local full-thickness mucosal flaps.
All palatal defects were considered complex. Complete hard palate closure was achieved after initial attempt in 3 dogs; 2 dogs had revision surgery before complete closure, and in 1 dog, closure failed and further treatment was declined. No complications or long-term consequences were associated with selective dental extractions.
Selective dental extractions before definitive surgical repair using mucosal flaps in a double-layer approach is an effective alternative when treating complex hard palate defects in dogs.
... Studies have been performed to prevent the attachment of scar tissue to the palatal bone. Surgical techniques that reduce the denudation of the palatal bone by replacing mucosa from autogenic cheek, palate and tissue-engineering oral mucosa membranes show some beneficial effects (Perko, 1974;Onizuka et al., 1996;Leenstra et al., 1999;Meng et al., 2007;Ophof et al., 2008;Kurokawa et al., 2008), but other attempts using low level laser therapy, biodegradable membranes, or tissue expansion did not show any significant long-term improvements (In de Braekt et al, 1991, 1995Van Damme et al., 1997). ...
BACKGROUND: The long-term goal of cleft palate repair is to provide normal maxillary growth and speech capacity. However, most surgical repairs of cleft palate result in areas of bone denudation on lateral aspects of the hard palate. It is widely acknowledged that palatal bone denudation and subsequent scar contracture resulting from cleft palate surgery can inhibit maxillary growth. METHOD: This study is designed to investigate the effect of the periosteum on growth patterns of the maxilla. A total of 32 three-week-old Sprague-Dawley rats were randomly divided into a control group and three experimental groups: a mucosa excision group, a mucosa-periosteum excision group and a periosteal graft group. Nine weeks postoperatively the skulls were prepared for study and palatal widths and lengths were determined. The experimental groups were investigated for various histological changes. RESULTS: There was no statistically significant difference for the maxillary measurements (palatal width and length) between the mucosa excision group and the periosteal graft group when compared with the control group. However, the mucosa-periosteum excision group compared to the control indicated a statistically significant decrease in the same measurements. There was also a statistically significant difference for the maxillary measurements between the periosteal graft group and the mucosa-periosteum excision group. It was demonstrated histologically that the density of the Sharpey's fibres and periodontal scar tissue showed a slight increase in the mucosa excision group and the periosteal graft group compared with the control group. In the mucosa-periosteum excision group, the density increased significantly as expected. CONCLUSIONS: All of these findings testify that retaining the periosteum or replacement with a periosteum graft after surgery can prevent the inhibition of maxillary growth.
... Studies have been performed to prevent the attachment of scar tissue to the palatal bone. 9,10 Surgical techniques that reduce the denudation of the palatal bone by means of local turnover flaps, buccal fat pad grafting, and free flaps showed some beneficial effects, [11][12][13] but other attempts with low-level laser therapy, biodegradable poly-(L-lactic) acid membranes, or tissue expansion show no significant long-term improvements. [14][15][16] In the partially split flap technique described by Leenstra et al, 11 the palatal mucoperiosteum is split parallel to the bony surface. ...
... 9,10 Surgical techniques that reduce the denudation of the palatal bone by means of local turnover flaps, buccal fat pad grafting, and free flaps showed some beneficial effects, [11][12][13] but other attempts with low-level laser therapy, biodegradable poly-(L-lactic) acid membranes, or tissue expansion show no significant long-term improvements. [14][15][16] In the partially split flap technique described by Leenstra et al, 11 the palatal mucoperiosteum is split parallel to the bony surface. This technique causes less scar formation, and the growth pattern of the maxilla is more normal. ...
Our aim was to compare the dentoalveolar development in beagle dogs after palatal repair according to the Von Langenbeck technique with and without implantation of a dermal substitute.
Nineteen beagles (age, 12 weeks) were assigned to 2 experimental groups and an untreated control group. Palatal surgery was performed with the Von Langenbeck technique in the 2 experimental groups. The dermal substitute Integra (Plainsboro, NJ, USA) was implanted in 1 experimental group, and the other served as sham group. Dental casts were made before surgery and at several times in all groups to measure dentoalveolar development. Transversal distances, arch depth, tipping, and rotation were determined. Histologic evaluations were performed at 3, 7, and 15 weeks after surgery. The degrees of reepithelialization and tissue organization were evaluated microscopically.
All wounds healed without complications. Scar tissue attached to the bone was found in both experimental groups. Deposition of bone in the Integra occurred after implantation, indicating its osteoconductivity. Transversal dentoalveolar development was similar in both experimental groups, but it was significantly less than in the control group.
Implantation of Integra after the Von Langenbeck procedure for palatal repair does not improve dentoalveolar development.
