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Cleft Palate and Acquired Palate Defects 181

• Flap necrosis if major palatine artery or
wound edges are compromised during
VetBooks.ir • Tongue movements, chewing on hard Diseases and Disorders
surgery
material, self-trauma (consider e-collar,
postoperative tube feeding)
Recommended Monitoring
Re-examination in 2 weeks for removal of skin
A B sutures at lips

CLEFT PALATE A, Congenital cleft palate. This 14-week-old dog is under general anesthesia and in dorsal PROGNOSIS & OUTCOME
recumbency; rostral is toward the bottom of the image. A congenital defect of the secondary palate (midline
cleft of the hard and soft palate) is seen (arrows). B, Repaired congenital cleft palate. The hard palate defect • Multiple procedures may be required to close
was repaired using the overlapping flap technique; note the exposed major and accessory palatine arteries a palate defect. Follow-up surgeries should
(arrowheads]. The donor area is left to granulate and epithelialize. The soft palate defect was repaired using not be attempted before healing (granulation
the medially positioned flap technique. (Copyright Dr. Alexander M. Reiter, University of Pennsylvania.) and epithelialization) of all tissues involved
(6-8 weeks).
• Poor prognosis for congenital soft palate
hypoplasia (restoration of a pharyngeal
Chronic Treatment flaps based on the angularis oris, caudal sphincteric ring and normal swallowing
Repair of primary palate defects: auricular, or superficial cervical arteries; function may not be achieved)
• Cleft of most rostral hard palate: recon- free tissue transfer with auricular cartilage • Guarded prognosis for secondary palate
structed by creating overlapping flaps of or microvascular composite grafts; flexible defects without surgical repair (risk of
oral (and nasal) tissue or advancement, bone membrane aspiration)
rotation, and transposition flaps harvested • Nonsurgical closure of hard palate defects by
from oral tissue only; removal of one or more using prosthetic devices (palatal obturators PEARLS & CONSIDERATIONS
incisors and canine tooth on the affected made of synthetic resin, silicone, or titanium)
side facilitates flap management. that are removable or attached to teeth Comments
• Cleft lip: reconstructive cutaneous surgery Ancillary care: The best chance of success is with the first
to provide symmetry (elective) • Pain control: maxillary nerve block (0.5% surgical procedure. Avoid electrocoagulation for
Repair of secondary palate defects: bupivacaine hydrochloride) intraoperatively hemostasis, handle flaps as carefully as pos-
• Midline hard palate cleft: overlapping flaps followed by opioids (e.g., hydromorphone sible, and avoid creating closure that is under
(preferred technique); medially positioned 0.1-0.2 mg/kg IV or IM as needed up to q tension. Referral to an experienced oral surgeon
flaps or unilateral rotation (single pedicle) 2-4h) and postoperative opioid medication is recommended.
flaps may be used; the harvested mucoperios- (butorphanol 0.2-0.4 mg/kg PO q 6-12h)
teal flaps must be supplied by major palatine or nonsteroidal antiinflammatories (e.g., Prevention
arteries; exposed bone is left to granulate and carprofen 2 mg/kg PO q 12h) for 4-7 days • Selective breeding
epithelialize. • Antibiotics: not required unless existing • Avoid gestational glucocorticoid administra-
• Midline soft palate cleft: medially positioned aspiration pneumonia tion and other insult during pregnancy (see
flaps (with at least a two-layer closure) or • Wound management: oral application of Etiology and Pathophysiology above).
overlapping flaps dilute chlorhexidine solution or gel for 4
• Unilateral soft palate cleft: tonsillectomy weeks; Elizabethan collar to prevent pawing Technician Tips
at affected side, followed by creation and at surgical site Technicians caring for patients with congenital
suturing of two nasopharyngeal and two cleft palate preoperatively and postoperatively
oropharyngeal flaps Nutrition/Diet should be skilled in correct tube-feeding
• Soft palate hypoplasia: bilateral tonsillectomy, Preoperatively in congenital cleft patients: technique and feeding tube care (pp. 1106
followed by bilateral creation and suturing of • Transoral tube feeding with milk replacer and 1107).
two nasopharyngeal and two oropharyngeal or other suitable diet (e.g., Hill’s a/d) until
flaps 3-4 months of age Client Education
Repair of acquired palate defects (depending ○ Supplies nutritional needs Management of patients with congenital cleft
on size and location): ○ Minimizes rhinitis palate requires intensive nursing care at home
• Defect in dental arch (p. 720) ○ Allows patient to mature: anesthetic for 2-4 months until surgery can be performed.
• Smaller, round to oval, middle to caudal purposes, greater strength of palatal tissues, Owners should be warned that multiple proce-
hard palate defect: split palatal U-flap with more working room in the oral cavity and dures might be required to completely close a
rotation flaps that must contain viable major oropharynx to effect repair congenital or acquired palate defect.
palatine arteries (original technique with Postoperatively:
two equally long rotation flaps or modified • Soft food, no chewing toys/treats for 4 weeks; SUGGESTED READING
technique with two unequally long rotation esophagostomy or gastrostomy tubes to Reiter AM, et al: Palate surgery. In Tobias KM, et
flaps) bypass the oral cavity are rarely needed. al, editors: Veterinary surgery: small animal, St.
• Larger palate defects (any location): labial- Louis, 2012, Elsevier, pp 1707-1717.
or buccal-based, overlapping advancement, Possible Complications AUTHOR & EDITOR: Alexander M. Reiter, DVM, Dr.
rotation, or transposition flaps; local axial Dehiscence causes: med. vet., DAVDC, DEVDC
pattern flaps based on the major palatine • Excess tension if inadequate mobilization of
and infraorbital arteries; distant axial pattern tissue for closure

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