Teaching Palatoplasty Using a High-Fidelity Cleft Palate Simulator

Sir: With great interest, we read the recent series of articles about rhinoplasty, “Teaching Palatoplasty Using a High-Fidelity Cleft Palate Simulator.”1 We would like to take the opportunity to further expand on the topic with this letter. One of 500 to 1000 babies is born with a cleft.2 Cleft palate is the most common of these facial clefts. The goal of cleft palate repair is to restore a mechanism for normal speech production; thus, reconstruction of the continuity of circular muscle in the palate is an important step in the treatment. Competency in cleft palate repair is required for completion of plastic surgery training for graduate medical education. It is a challenging procedure to teach and assess in the operating room because of the delicate tissue handling that is required, limited visibility in the infant oral cavity, and potential complications that can arise from subtle technical errors. Supervising surgeons are reluctant to allow trainees to perform this procedure, making it impractical for trainees to learn or be evaluated on live patients. As a result, training in cleft palate surgery takes time, requiring gradual increases in hands-on experience. The article by Cheng et al. demonstrates that the cleft palate surgery simulator is an excellent training platform for practice in preparation for operative experience. However, for developing countries, the high-fidelity cleft palate simulator is too expensive for most medical and dental colleges, which can not afford the training platform. Meanwhile, for the patients’ benefit, a similar training system for junior surgeons is needed so that this procedure can be performed in the infant oral cavity, because there are thousands of cleft patients waiting for good treatments in their countries. Here, we present a new cleft palate simulator for teaching palatoplasty in developing countries that is simple, inexpensive, and easy to make. As the article above mentioned, the key points of the cleft palate simulator are to choose a palatal muscle–like material and simulate the limited visibility in the infant oral cavity. Thus, in our training platform, we chose the tongue of domestic pigs as the palatal muscle–like material to teach and assess how to handle the delicate tissue, dissect and reconstruct the continuity of circular muscle, and design the double-opposing Z- palatoplasty. (See Figure, Supplemental Digital Content 1, which shows the steel frame for the new cleft palate simulator, https://links.lww.com/PRS/D141.) Sleeve openings of surgical gloves were used to simulate the limited visibility in the infant oral cavity. Meanwhile, we designed a new frame to build the new cleft palate simulator for teaching palatoplasty (Fig. 1). (See Figure, Supplemental Digital Content 2, which shows how to simulate double-opposing Z-palatoplasty with the tongue of the domestic pig, https://links.lww.com/PRS/D142.)Fig. 1.: The new cleft palate simulator for teaching palatoplasty in developing countries. It is simple, cheaper, and easy to make. (Above) New design for how to build the new cleft palate simulator with the tongue of domestic pigs. (Below) Sleeve opening of surgical gloves.Although our new cleft palate simulator is not as excellent and high-fidelity as that described by Cheng et al., it will be of greater benefit to junior surgeons for completion of plastic surgery training because of the simple design and the less expensive materials, which are easier to get in developing countries. Possibly, our cleft palate simulator can benefit junior surgeons and patients in developing countries. DISCLOSURE None of the authors has a financial interest in any of the products or devices mentioned in this communication. Xiaoxiao Pang, Ph.D., D.D.S.Chao Yang, Ph.D., D.D.S.State Key Laboratory of Oral DiseaseChengdu, People’s Republic of China Bing Shi, D.D.S., Ph.D.Cheng-hao Li, Ph.D., D.D.S.State Key Laboratory of Oral DiseaseDepartment of Cleft Lip and Palate SurgeryWest China Stomatological HospitalSichuan UniversityChengdu, People’s Republic of China