Surgical anatomy of cleft palate: a three-dimensional computer model.

Cleft palate anatomy is challenging to appreciate. This study aimed to develop clear and comprehensive 3D models of cleft palate anatomy from a surgical perspective for cleft palate repair. Cadaver dissections, the Visible Human Project, literature review, and surgical experience were used to obtain consensus on cleft palate anatomy. A computed tomography scan was segmented using 3D Slicer to develop bony anatomy as the foundation for the development of overlying soft tissue structures. Computer modelling software, ZBrush and Blender, were used to refine the bony model and to develop 3D models of soft tissue anatomy de novo. A 3D computer model of a Veau 2 cleft palate was created, complete with a hard palate and skull base foundation. The superior constrictor and buccinator were modelled to represent the oral cavity. The palatopharyngeus (PP) and palatoglossus were modelled, with the PP comprising an oral and nasal head enveloping the levator veli palatini within the middle third of the velum before inserting into the posterior hard palate shelf medially. The tensor veli palatini (TVP) was modelled with two insertions: (1) a lateral tendinous nasal component and (2) an oral and medial aponeurosis. A seroglandular/adipose layer, periosteum, blood vessels and mucosa were incorporated. A realistic and accurate 3D computer model of cleft palate anatomy was developed using four methods to obtain consensus. The model represents the clearest representation of cleft palate anatomy relevant to surgeons who perform cleft palate repair.