Primary veloplasty or primary palatoplasty: some preliminary findings.

Staged palatal closure was carried out in 30 children. The soft palate was closed at 9 months and the hard palate at 5 years. These patients were followed up for 7 years, and it was found that although the incidence of lateral crossbite was reduced in both unilateral and bilateral cases, the speech results were less satisfactory than those obtained with total palatal closure. In this series, there were two fistulae at the junction of the hard and soft palate. This was related to difficulty in closing this area in some patients at the time of the second operation. As a result, the procedure is not advised. An alternative palatal closure technique is described. This technique consists of nasal layer closure, careful dissection and reconstruction of the levator musculature, transverse division of the nasal layer, insertion of a buccal flap for lengthening, and closure of the oral layer with Veau flaps without dissection behind the tuberosities and with almost total closure of the lateral donor sites on the palatal shelves. In this way there is minimal scarring, particularly in the retrotuberosity area. This is felt to be important since it would seem from studies of facial growth that this is a much more significant area than the palatal shelves.