Piezoelectric Palatine Foraminotomy in Wide Cleft Palate Repair: A New Approach for Safe Neurovascular Pedicle Mobilization.

Authors

Ömer Kokaçya, İbrahim Tabakan, Abdullah Arslan, Gazi Kutalmış Yaprak, Ali Kuru

Published in

Plastic surgery (Oakville, Ont.). Pages 22925503261477397. Aug 26, 2026. Epub Aug 26, 2026.

Abstract

Surgical repair of large cleft palates is challenging and is associated with high postoperative fistula rates. Midline tension is a critical factor in fistula formation. Foraminotomy enables increased medial mobilization of the palatal flaps, particularly in cases in which standard palatal closure would otherwise result in excessive midline tension; however, this procedure carries a risk of neurovascular pedicle injury and subsequent flap necrosis. In this study, we present our surgical technique for piezoelectric palatine foraminotomy to facilitate palatal flap mobilization and tension-free closure in large cleft palate repair.
Seventeen patients with wide cleft palates (≥15 mm cleft width; Veau class II-IV) who underwent primary palatoplasty with piezoelectric foraminotomy between 2017 and 2020 were reviewed. All procedures were performed by a single senior surgeon. The piezoelectric device equipped with a sinus lift tip was used to enlarge the palatine canal via controlled removal of the posteromedial bony wall, allowing tension-free medial mobilization of the neurovascular pedicle. Postoperative outcomes including fistula formation, flap necrosis, and neurovascular complications were assessed over a minimum 12-month follow-up period.
No intraoperative or postoperative neurovascular pedicle injury, flap necrosis, or wound infection was observed. Oronasal fistula developed in 3 patients (17.6%), all with Veau class III or IV clefts, located at the hard palate-soft palate junction.
Piezoelectric osteotomy for palatine foraminotomy is a feasible, controlled, and soft tissue-preserving technique that may enhance the safety of neurovascular pedicle mobilization in wide cleft palate repair.

PMID:
42732259
Bibliographic data and abstract were imported from PubMed on 13 Sep 2026.

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