Use of the Sphenoid Flap in Repair of the Wide Cleft Palate.

OBJECTIVE: In wide palatal defects, closure of the nasal layer can prove a considerable challenge. Mobilizing nasal flaps posteriorly usually facilitates soft palate closure. However, the defect is often too wide within the hard palate; hence, bilateral vomerine flaps are frequently required. Despite this, there is often a small defect in the nasal layer at the posterior septum (typically equating to the hard-soft palate junction), which has to be left to heal by secondary intention with the resulting increased risk of fistula formation and the potential deleterious long-term effect on speech due to cicatricial migration of the reconstructed levator sling anteriorly. We describe our experience in the use of the sphenoid flap to obtain tension-free primary closure of the nasal layer. METHODS: A retrospective multi-center study assessing all sphenoid flap procedures undertaken at both Birmingham Children's Hospital and Great Ormond Street Hospital. Key demographic and medical data was collected pre-, peri-, and postoperatively across the 2 sites. RESULTS: A total of 66 patients underwent the use of a sphenoid flap to aid closure of the nasal layer. The average age at time of repair was 9.7 months. More than half (55%, n = 36) were isolated cleft palates, and 35% (n = 23) were BCLPs. Forty-two percent of all patients had Robin sequence. The average cleft width was 14.4 mm. The overall fistula rate was 25.8% (n = 17). CONCLUSIONS: We describe the operative technique, indications, and our experience in the use of the sphenoid flap in wide cleft palate repair.

Split calvarial bone graft in cranio-orbital sphenoid wing reconstruction.

Sphenoid wing defects of the posterior orbit and frontal and middle cranial fossae, secondary to tumor ablation, create difficulties in orbital and cranial base reconstruction. Autogenous split calvarial bone grafts harvested at the time of neurosurgical tumor ablation were used to reconstruct sphenoid wing defects in nine patients between July 1983 and January 1993. Meningioma is the most common tumor resected in this series, followed by fibrous dysplasia. Patient follow-up ranged from 1 to 5 years with a mean of 3 years. Calvarial bone grafting was performed to restore continuity of frontal bone, supraorbital ridge, orbital roof, and lateral wall and floor. All patients demonstrating proptosis showed either complete resolution or significant improvement postoperatively by exophthalmometry. Postoperative pulsatile exophthalmos occurred transiently in one patient but resolved spontaneously. Postoperative diplopia occurred in two patients, which subsequently resolved within 6 weeks. There were no incidents of postoperative osteomyelitis or bone graft loss within the reported postoperative period. Conventional and three-dimensional computed axial tomographic scans did not demonstrate bony resorption resulting in structural instability in any of the cases with this reconstructive method.