Basic and Advanced Palate Surgery

Congenital Defects 

Congenital defects of the primary palate appear as harelip (cleft of the lip) or cleft lip (cleft of the lip and most rostral hard palate) and rarely result in clinical signs beyond mild local rhinitis. The most rostral palate and the floor of the nasal vestibule are reconstructed by creating overlapping double flaps and advancement, rotation or transposition flaps of both oral and nasal tissue or flaps that are harvested from oral soft tissue only. Extraction of teeth on the affected side 6 to 8 weeks prior to surgery will facilitate flap management. Complete lip reconstruction is challenging.
Congenital defects of the secondary palate appear as cleft hard and/or soft palate and are usually located in the midline. Soft palate defects without hard palate defects may sometimes be unilateral, or the soft palate may be entirely absent. Clinical signs include failure to create negative pressure for nursing, nasal discharge, sneezing, nasal reflux, rhinitis, coughing, gagging, tonsillitis, aspiration pneumonia, and poor weight gain. Surgical correction is best performed on animals at 3 to 4 months of age. Hard palate clefts are repaired with an overlapping flap technique, and soft palate defects are repaired with a medially positioned flap technique. Repair of a unilateral soft palate defect is facilitated by unilateral tonsillectomy prior to flap surgery.

Defects Acquired After Birth

An oronasal fistula is commonly seen in the area of a maxillary canine tooth with severe periodontal disease that results in loss of adjacent incisive and maxillary bone. The tooth may often be missing, and an opening between the oral and nasal cavities exists. Clinical signs of a chronic oronasal fistula include sneezing and ipsilateral nasal discharge. Repair is achieved by elevating and suturing a buccal advancement flap over the defect.
Traumatic cleft palate is a ‘fresh’ midline cleft of the hard palate often associated with falling from heights in cats. The displaced bony structures are approximated with digital pressure, followed by suturing of the torn palatal soft tissues in a simple interrupted or mattress pattern. If the separation is extensive, a twisted wire can be placed between and secured to the maxillary canines. The wire is reinforced with bis-acryl composite.
Electric cord injuries occur most often in young animals.
Life-threatening airway compromise may be related to pulmonary edema from smoke inhalation or electrical exposure. Initially, the patient is managed conservatively (lavage with saline or dilute chlorhexidine and empirical antimicrobial therapy), and the injured tissues are left to necrose until viable tissues have declared themselves. Once the necrotic tissue is evident, surgical intervention may be initiated (sharp/blunt debridement). It may take several days before the full extent of local injury is defined. [...]