الفهرس 
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Abstract
Summary
Cleft palates are among the commonest craniofacial abnormalities. They result from a failure of fusion of primary and secondary palate components during the second month of gestation. They have an incidence of about 1 in every 2000 to 2500 births. They are usually but not always associated with a cleft lip. In a small percentage of cases, the cleft palate is one of multiple congenital anomalies in the context of a major genetic syndrome. The extent of the cleft varies: Some involve only the soft palate; others extend through the hard palate but spare the alveolar ridge, while others are complete. The defect may be unilateral or bilateral.
Cleft palate has negative effects on speech, hearing, appearance, and psychology can lead to long lasting adverse outcomes for health and social integration. Typically, children with these disorders need multidisciplinary care from birth to adulthood and have higher morbidity and mortality throughout life than do unaffected individuals.
Many challenges endanger cleft palate repair as paucity of tissues in wide cleft palates, inability to separate the suture lines or use the usual antiseptics, continuous exposure with trauma to the tissues by food and exposure to infections in an area that is famous of that as being near tonsils and adenoids.
Cleft palate repair is not free of complications. The most frequent complication of palatoplasty is the occurrence of a fistula. Other complications described include the complete wound dehiscence, airway obstruction, upper respiratory tract infection, pneumonia, bleeding, feeding difficulties, aspiration, hyperthermia, postoperative airway obstruction, otitis media, and even mortality.
Repair of the cleft palate serves to restore the separation between the oral and nasal cavities thus creating a functional velopharyngeal mechanism for feeding, speech, and Eustachian tube (ET) function, with the intent of minimizing the repair‘s impact on maxillary growth.
As each cleft palate is morphologically unique, the surgical technique that one selects depends on the alveolar, hard palatal, and soft palatal deficits that are identified. It is not uncommon to integrate components of several types of palatoplasty in order to achieve the goals of oronasal separation, restoring a functional velopharyngeal mechanism, with attention directed to minimizing the impact on maxillary growth.
In our study was during the period from august 2021 and end in July 2023 during which all patients with primary cleft palate, who were referred from the outpatient surgery clinic at Beni-Suef university hospital, were included in our study and they were forty patients (20 patients in each group). They underwent primary cleft palate repair, group A with Furlow palatoplasty with buccal fat flap supported with buccinator myomucosal flap to left side and group B with two flaps palatoplasty (bardach technique).
Furlow‘s palatoplasty has been widely used in the treatment of cleft palate. Double-opposing Z-plasty of the soft palate can reposit and overlap the divergent palatal muscle and lengthen the soft palate. By application of Z-plasty, the straight median scar in the soft palate can be avoided and this should reduce the postoperative shortening in the anteroposterior direction.
In group A, we used buccal BFF with primary palatoplasty in the Furlow technique, and we observed its role in filling the dead space under the mucoperiosteal flap and reducing tension on Z flaps. Furthermore, BFF has no effect on facial contour. Because of the simple nature of
operation, healing ability, and low complication risk, We also advise against using a suction device when applying BFF because we experienced suction of a portion of the flaps during their application. Overall, the use of BFF in palatoplasty is a helpful and reliable method that may be utilized in palatal repair, and we recommend conducting more separate research on a large number of patients. However, During the study it was found that taking buccinators myomucosal flap (BMMF) will add a benefit of substituting part of the mucosal defect in the palate besides will support the buccal fat taken and will give easy access for harvesting the buccal fat, so after the first two cases in group (A), BMMF was added routinely in the Lt side to substitute for the defect.
The two flap palatoplasty provides a two-layer and three- layer closure of the hard and soft palate. Bardach stressed the goal of tension free closure of the entire palate at an early age more over he maintained that the creation of a muscle sling was essential to speech and VPI .
There are no deaths or major life threatening complications in this study.
group A: complications were in 9 cases (45%) in our study, inform of oronasal fistulae in four (20%) cases. One case had (5%) complication of complete wound dehiscence, two cases (10%) had complications of wound infection, one cases (5%) had complication of Upper airway obstruction and one case (5%) had complication of reactionary hemorrhage at recovery from anesthesia.
In group A : - there is no donor site (of the flaps) complications (no parotid duct injury, no dehiscence, no infection and no facial nerve injury).
group B: complications were in 6 (30%) cases in our study. Two (10%) cases had complications of oronasal fistulae; two (10%) cases had complications of wound infection at surgical site, one (5%) case had complication of Upper airway obstruction and one (5%) cases had complication of reactionary hemorrhage at recovery from anesthesia.