الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 168 |  |  |
| | | from | 168 | | |
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 bilatera.
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 January 2019 to June 2019 during which all patients with primary cleft palate, who were refered from the outpatient surgery clinic at Beni-Suef university hospital, were included in our study and they were Twenty patients. They underwent primary cleft palate repair by Two flaps palatoplasty technique with use of human fibrin glue in the repair.
Fibrin glue is a biological tissue adhesive which is primarily made of fibrinogen and thrombin. In the presence of calcium chloride, these two components cause fibrinogen to polymerize to form the insoluble fibrin clot.
Fibrin glue was prepaired from fresh frozen plasma to obtain thrombin from it by adding calcium chloride to the plasma and using centrifuge at 3200 cycles per minute for 20 minutes at 4-6C in a cooling centrifuge, and from cryoprecipitate to obtain fibrinogen.
A dual-syringe was used for application of fibrin glue with one side containing one centimeter fibrinogen and the other side containing one centimeter thrombin, after being prepared.
Fibrin glue will be applicated by the dual-syringe between the oral and nasal layers of palatal repair and at suture line also.
Close observation postoperatively for respiratory distress, face edema and puffiness of the eyes, heart rate and urine output to detect any early signs of fibrin glue allergy and later on detection of other postoperative complications as palatal fistula formation.
According to type of complication we had 6 complications (30%) including 2cases with nasal obstruction, one reactionary haemorrhage, one wound infection and 2 palatal fistulae.
According to number of complicated cases we had 5 patients(25%) with postoperative complications including nasal obstruction, reactionary haemorrage, wound infection and oronasal fistula. Comparing our results with other studies showed that we had lower rate of palatal fistula.
According to the results of this study we recommend the use of fibrin glue in primary cleft palate for better outcome and less complications. Further studies are needed for more informations and better evaluation of its use but the results are encouraging.