A prospective study of the medial cleft edge as a cause of soft palate shortening and a simple technique to restore length during palatoplasty.

Abstract

A thin rim of fibrotic thickening of the medial cleft edge with distinctive histopathological features is a constant finding in palatal clefts. We hypothesized that this scar-like tissue acts as a contracture band by tethering the soft palate and contributes to its anteroposterior shortening. We aimed to quantify the lengthening achieved by releasing it during palatoplasty. Prospective observational study. Specialized cleft center in a tertiary care hospital in Southern India. Consecutive patients who underwent cleft palate repair between January and September 2023 (n = 46). Per-operative antero-posterior lengths of the soft palate were measured at rest and again when gently stretched before the beginning of the procedure. Following release of the fibrotic tissue at the cleft edge by short back-cuts or excision, measurements were repeated and differences recorded. There was a mean increase of 38.16% (5.04 ± 2.48 mm) and 35.78% (4.79 ± 2.31 mm) in the antero-posterior length of the hemi-palate measured at rest on the left and right sides respectively. The corresponding values were 58.30% (8.54 ± 3.77 mm) and 57.37% (8.43 ± 3.83 mm) when the soft palate was gently stretched (p < 0.001). We localized the medial cleft edge tissue as a distinct addressable contributor to the antero-posterior shortening of the soft palate associated with clefts and demonstrated that substantial lengthening can be achieved when it is eliminated. This provides a scientific basis for palatoplasty techniques which effectively restore soft palate length without extensive invasion into normal tissues.