Temporal osteocutaneous island flaps for complete reconstruction of cleft palate defects.

In each of four patients, closure of a wide cleft palate was performed with a temporal osteocutaneous island flap (TOCI flap) based on the superficial temporal artery. These were fabricated island fasciocutaneous flaps composed of temporoparietalis fascia and galea with pericranium, surfaced with split skin grafts. Two flaps carried with them a segment of vascularized parietal bone (TOCI-I). In the other two flaps, the osseus component was supplied by placing an osteogenic powder in a pericranial pocket: a temporal artery "osteogenic" cutaneous flap (TOCI-II). In each case the flap closed the defect and lengthened the palate without the need for elevation of palatal mucoperiosteum. Growth of the parietal bone segment has been observed in the first patient (the only one to have a follow-up CT scan). This patient, the eldest, is developing normal speech so far. The others are still too young for evaluation.