Musculature of the soft palate: clinico-anatomic correlations and therapeutic implications in the treatment of cleft palates.

ABSTRACT

OBJECTIVE: Hypoplasia of the maxilla, often described as a classic sequela to surgical repair of the cleft palate, has been rare in our experience. We believe that our surgical technique, which includes dividing the nasal mucosa and the abnormal muscular insertions at the posterior border of the hard palate, is an important factor in preventing this sequela. METHOD: We compared the anatomy of 12 normal palates in cadavers to the anatomy of cleft palates seen at operation and to the anatomy of one cleft palate in a fetus aged 34 weeks. RESULTS: In cleft palates, the muscular fibres have an abnormal sagittal orientation, inserting on the posterior border of the hard palate. CONCLUSION: The division of both the nasal mucosa and these abnormal muscular insertions at the posterior border of the hard palate enables the surgeon to eliminate the abnormal posterior pull of these fibers on the maxilla.