A T-shaped musculomucosal buccal flap method for cleft palate surgery.

The primary aim of cleft palate surgery is not only to close the cleft palate but to push back the palate by repositioning the levator muscle to ensure that normal speech is obtained. Although the pushback operation using a mucoperiosteal flap is a readily effective method for velopharyngeal closure, postoperative fistula sometimes occurs, especially when the cleft palate is wide. Furthermore, postoperative maxillary deformity, possibly due to elevating the mucoperiosteal palatal flap, is extremely troublesome. For the purpose of pushing back the nasal mucosa, we applied the Kaplan buccal flap method, which is also applicable for reestablishing the levator muscle sling. The other buccal flap is covered on the hinged flap of the pared cleft margins. This results in far less disturbance of maxillary growth. We call it the T-shaped buccal flap method, and we have applied it in over 30 patients with various cleft palates and have obtained satisfactory results.