What We Do: Greater Palatine Medializing Foraminal Osteotomy for Repair of the Wide Cleft Palate

Wide cleft palates (>15-mm gap) present a number of challenges to the surgeon tasked with their repair (Bardach, 1999). Eliminating the need for secondary surgery due to fistula formation can reduce additional anesthetic and scarring risks and optimize early speech development. Greater palatine foraminal osteotomy is a useful surgical adjunct that allows additional medial movement of oral mucoperiosteal flaps to aid in tension-free closure of the oral layer. We use a technique similar to that described by Seibert in 1995 with a few modifications. Closure of the nasal layer in these wide clefts can be achieved using a sphenoid flap, a technique recently published by our unit (Khan et al, 2018).