Dissection in the Pyramidal Space for Effective Relief of Tension in Cleft Palate Repair

Objective Although several methods of note have been reported for the repair of cleft palate, wound separation and oronasal fistula can still occur. This study reports a useful technique of dissection in the pyramidal space for adequate release of tension and the prevention of palatal fistula. Methods A total of 404 consecutive patients with cleft palate with or without cleft lip who had received standard surgical repair were evaluated. The mucoperiosteal flaps were raised from the hard palate. Dissection was performed in the pyramidal space to expose the greater palatine foramen, neurovascular pedicle, pyramidal process of the palatine bone, opening to the space of Ernst, and hamulus with tensor veli palatini aponeurosis. The restricting ligamentous fibers lateral and posterior to the pedicle were released. The hamulus process was divided at its root and pushed medially for further relief and medial mobilization of the flap. Closure of the flaps was achieved with minimal tension in the midline. The patients received regular postoperative follow-ups. Results Only 1 case was found to have postoperative palatal fistula, resulting in a fistula rate of 0.25% during the 11-year study period. Conclusion Adequate dissection in the pyramidal space helped to close the palatal flaps with minimal tension and prevent the formation of palatal fistula.