Summary
The anatomy of the palate has been extensively described, with a predominant focus
on palatal musculature. There are no biomechanical studies investigating the effects
of surgical maneuvers on the palate to aid cleft closure. This study aims to describe
the soft tissue attachments at different zones and quantify the movement following
their release. Fourteen adult cadaver heads were dissected. The palates were split
in the midline and five maneuvers described: Step 1, over the hard palate; Step 2,
around the greater palatine pedicle; Step 3, over the palatine aponeurosis; Step 4,
over the hamulus; and Step 5, resulting in a hamulus fracture. The movements across
the midline at the posterior nasal spine following each maneuver were measured.
The age range of the 14 heads was between 60 -75 years. Completion of steps 1 and
2 over the hard palate obtained a mean release of 2.6 and 2.0 mm, respectively. The
largest movements occurred at Step 3 (5.7 mm) and Step 4 (3.5 mm), after releasing
attachments at the posterior hard palate and palatine aponeurosis. Steps 3 and 4 dissections
exhibited cumulative release, with a maximum movement with Step 3 (p < 0.05). Isolated fracture of the hamulus (Step 5) yielded a mean movement of 1.4
mm. Individual steps of dissection are described with respect to releasing soft tissue
attachments. Medial movement of the oral mucosa is quantified with each step of dissection.
The greatest release occurred with dissection overlying the palatine aponeurosis posterior
to the hard/soft palate junction. Additional dissection along the hamulus (without
fracture) added significantly to this release.
Keywords
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Article info
Publication history
Published online: April 09, 2014
Accepted:
February 5,
2014
Received:
September 14,
2013
Footnotes
☆Oral presentation at: (1) 12th Annual Conference of the Indian Society of Cleft lip, Palate and Craniofacial anomalies (Indocleft 2013) at Nagpur, India, 17–19 January 2013. (2) 12th International Congress on Cleft lip/Palate and Related Craniofacial Anomalies/American Cleft Palate Craniofacial Association at Orlando, FL, USA, 5–10 May 2013.
Identification
Copyright
© 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
