No definitive procedure for cleft repair has been identified
yet as the gold standard. Accordingly, this work tried to appraise
the hypothesis that if the bony detachment and full retropositioning
of the levator veli palatini muscle can ideally present an anatomical
C-shape muscular sling restoration and if this is accompanied with
pushback palatoplasty, would this present a better result in terms of
tissue fistulation and phonetic impairment? A series of 74 different
degrees of palatal clefts were operated by pushback palatoplasty
combined with a modified approach of the levator vili palatini. This
muscle was dissected only from the oral mucosa while kept attached
to the nasal one as a musculo-nasomucosal unit. This unit was
completely detached from the bony margin of the hard palate and
then medially rotated and retropositioned in a typical C-shape mobile
sling. Evaluations included suture line assessment and fistula development,
and following the child’s need for speech therapy. There
were no intraoperative complications. Definite anterior fistulae with
nasal air and foot leakage were observed in 2 cases. Four cases had
postoperative velopharyngeal incompetence with a need for speech
therapy. Tension-free closure, lower risk of fistula, good restoration
of velopharyngeal functions, ability to be performed on all cleft
types, ability to provide a good intraoperative exposure, and being a
single stage seem to be the most important advantages of this unpublished
technique.