Two different hard palate closure techniques in two-stage palatoplasty: effects on velopharyngeal closure and articulation.

Two different hard palate closure techniques, in two-stage palatoplasty, was evaluated in 12 patients. The lip and soft palate were closed at 3 to 7 months of age. The patients were then divided into two groups of six and the hard palate closed at 17 to 23 months of age, either by a vomer flap (VF) with a skin graft (Osada's two-stage palatoplasty) in the VF group, or by the push-back (PB) procedure of the mucoperiosteal flap in the PB group. Velopharyngeal closure (VPC) during a gag reflex before and after hard palate closure, and the articulation of these patients after closure, were evaluated and compared between the two groups. Regarding VPC before hard palate closure, three "Poor" and three "Borderline" outcomes were noted in each group. We conclude that, by introducing the pharyngeal flap, the patients in the VF group obtained good articulation, actually comparable to that in the PB group.