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Cleft Palate Repair: Predictive Factors of Difficulty and Planned Strategies to Solve It.

INTRODUCTION
A cleft of the primary and/or secondary palate involve almost every function of the face except vision. Today, an isolate cleft palate or a complete cleft lip/palate should not be considered as an adverse condition because surgical repair has reached a highly satisfactory level. Nevertheless, for the average cleft surgeon palatoplasty still remains an enigma.


PLANNING THE STRATEGY
Having an observational and an anatomical measurement methodology of some pre op parameters, it would make possible to predict a complicate repair. In that way, the surgeon can select the best closure strategy, minimize surgical aggression, and even prevent the presence of sequels. Palates must be reviewed just before the operation, under general anesthesia, with the patient and the Dingman retractor in place. By using a precision caliper at least 4 parameters should to be considered to select the right strategy.


CONCLUSIONS
Since 2009, author has selected the alveolar extension palatoplasty with complete muscle dissection and retro positioning, plus posterior pillars elongation with a hemi-uvula rotation and reconstruction as the procedure of choice for complete primary cleft palate repair. The utilization of the pre op mentioned parameters to identify cleft palate diversity and severity seems to be useful to select the correct strategy to perform cautious surgical procedures.