A new method for achieving complete two-layer closure of a massive palatal cleft.

A new surgical technique was used to provide a complete two-layer closure of an extremely wide cleft palate in cases in which the width of the cleft defect is larger than the sum of the combined widths of the remaining palate. The oral layer of closure is obtained by the use of turnover flaps of the nasal mucoperiosteum based on the margin of the cleft. This recruits the nasal mucosal flap into the oral layer of closure and allows adequate width for complete closure of the oral layer of the cleft. The nasal layer of closure is obtained by the use of a wide, long, superiorly based pharyngeal flap. This technique provides, in a single surgical procedure, a complete two-layer closure of extremely wide palatal defects. Previously, staged procedures were necessary to obtain a complete two-layer closure, or if a single procedure was performed, an incomplete two-layer closure resulted.