Hard palate repair: split defect in Cats (Felis) | Vetlexicon
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Hard palate repair: split defect

ISSN 2398-2950

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Synonym(s): "Sandwich" technique

Introduction

  • Closure of traumatic or congenital defect in the hard palate by an overlapping 'sandwich' repair technique.

Uses

  • Repair of hard palate defects Cleft lip and palate.
  • This injury is often seen as part of the 'high rise syndrome' in urban cats which have fallen from balconies.
  • Conservative or simple surgical repairs may be appropriate (see Alternatives).

Alternative techniques

  • Conservative treatment (liquidized food, antibiotics, analgesics) and healing by second intention Wound: second intention healing is often successful in mild to moderate cases.
  • Simple interrupted appositional sutures in palatine soft tissues can also be utilized in recent and uncomplicated injuries.
  • Sliding bipedicle mucoperiosteal flaps are simple and appropriate, however, the repair lies directly over the defect and tension may be a problem.

Time required

Preparation

  • 5 minutes.

Procedure

  • 1 hour.

Requirements

Materials required

Minimum equipment

  • Standard surgical pack.
  • Periosteal elevator.

Minimum consumables

  • Swaged-on synthetic monofilament absorbable suture material, 3/0 to 4/0, eg polydioxanone.

Other requirements

Preparation

Restraint

Technique

Approach

Step 1 -

  • Incise one margin of the palate defect and elevate the mucoperiosteum several mm in from the edge of the cleft. This zone will receive the free edge of the reflected flap and form a 'sandwich'.

Core procedure

Step 1 -

  • Elevate a suitably wide mucoperiosteal flap from the other side of the defect.
  • Note:
    • The flap will hinge at the margin of the cleft, so the incision should parallel the dental arcade and be close to the teeth.
      Ensure the flap is wide enough to bridge the gap!
    • After making the incision with the blade, use a periosteal elevator to raise the flap neatly.

Step 2 -

  • Rotate the flap to cover the palate defect. The oral mucosa of the flap now becomes the deep layer of the repair and is hidden from view.

Step 3 -

  • The free edge of the rotated flap is tucked between the mucoperiosteum and the hard palate on the opposite edge of the defect, in the area prepared in Step 1 above.

Exit

Step 1 -

  • Horizontal mattress sutures of synthetic absorbable suture material (polydioxanone) are placed along the line of overlap.

Step 2 -

  • Any co-existing soft palate defects are closed in layers, using release incisions to manage tension.

Exit

Step 1 -

  • Horizontal mattress sutures of synthetic absorbable suture material (polydioxanone) are placed along the line of overlap.

Step 2 -

  • Any co-existing soft palate defects are closed in layers, using release incisions to manage tension.

Aftercare

Immediate Aftercare

General Care

  • Give liquidized or soft food postoperatively.
  • Consider esophagostomy Esophagostomy feeding tube placement or gastrostomy feeding tubes in severe trauma cases/debilitated animals.

Potential complications

  • Dehiscence if sutured under tension or traumatic surgical technique.
  • Aspiration pneumonia if repair fails.

Outcomes

Complications

  • Chronic rhinitis Rhinitis if defect persists.

Reasons for treatment failure

  • Major trauma.
  • Technical problems in managing tension or handling friable tissues.

Prognosis

  • Generally good for trauma cases.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Marretta S M, Grove T K, Grillo J F (1991) Split palatal U-flap: a new technique for repair of caudal hard palate defects. J Vet Dent (1), 5-8 PubMed.