How I reconstruct palatal defects and cleft lips

Introduction

Congenital and acquired hard palate defects are common in small animals. These defects are clinically relevant because they often result in poor nursing with growth retardation and/or malnutrition, chronic rhinitis, and aspiration pneumonia. The morphological features of congenitally acquired cleft lip, cleft palate, and cleft lip and palate are very variable.¹

Patient age, patient size, and defect characteristics should be taken into consideration when planning and assessing prognoses for surgical repair of congenital palatal defects in dogs.²

Several surgical techniques have been described for palatal defect repair in dogs and cats. Traditionally, hard palate defects are repaired using local mucosal flaps to cover the area and anatomically isolate the oral from the nasal cavity. However, a common challenge is large defect size and a relatively small amount of surrounding soft tissues, which may impede successful repair. Definitive closure of palatal defects often requires a multi-stage approach. Successful surgical correction may also depend on the precise location and distribution of the defect, integrity and quality of the surrounding tissues (i.e. healthy, and intact mucoperiosteum versus fibrous tissues from previous failed surgical attempts), size of the associated bony defect, among others.

Failure of hard palate defect repair using mucosal flaps may occur because of excessive tension at the suture lines when the size and configuration of the flaps is not appropriate in relation to the defect size, shape, and location. Other cited causes for failure include infection of the surgical site, compromised blood supply, poor tissue quality, lack of underlying bony support at the suture lines, use of suboptimal suture materials and/or patterns, among others. When choosing the surgical technique, these factors must be considered to optimize the likelihood for successful repair. [...]