An Adult Case of Unilateral Cleft Lip and Palate Treated by Primary Palatoplasty, Alveolar Bone Grafting and Secondary Repair of Cleft Lip and Nose

Abstract

We report a rare neglected case of an adult with unilateral cleft lip and palate. The patient was a 20-year-old man who presented to our department with complaints of palate formation and tooth alignment. Cheiloplasty alone had been carried out at a certain university three months after birth, but subsequent medical treatment had been neglected for a long time. We observed an unoperated cleft palate with oronasal fistula around the alveolar cleft and secondary deformities of the lip and nose. Hypernasality and slight articulatory disorder were noted. We planned a primary palatoplasty with alveolar bone grafting and secondary repair of the lip and nose in consideration of postoperative orthodontic treatment. After the operation, we noted modification of the uvula, but progress was good. Speech training and orthodontic treatment are currently being continued. Since this case was an adult, we considered it to be much more important to close the alveolar cleft rather than active acquisition of velopharyngeal dysfunction. Therefore, we modified the design: the amount of push-back was minimized, the exposed area of the bone at the front of the palate which arises after the operation was made as small as possible, and the bone graft part with oronasal fistula was covered with sufficient lateral gingival mucoperiosteal flap in conjunction with a palatal flap. Comparatively good recovery was obtained and the patient and his family are satisfied.