Palatal microcirculation in minimal-incision cleft palate repair: Impact of lateral releasing incisions - A controlled intraoperative study

Background Tissue perfusion is critical for wound healing after cleft palate repair. Many palatoplasty techniques incorporate lateral releasing incisions for tissue mobilization, yet their impact on palatal microcirculation remains unclear. Methods In this prospective cohort study, children aged 7–15 months underwent primary cleft palate repair using medial-only or medial-and-lateral incision palatoplasty; children undergoing cleft lip repair alone served as controls. Tissue oxygen saturation (StO₂%) was measured noninvasively at the premaxilla, hard and soft palate before and after surgery using visible light spectroscopy. The primary outcome was change in StO₂% (ΔStO₂%). Secondary outcomes included perioperative complications, fistulas, and associations with cleft severity assessed by the palatal index. Results Seventy patients were included. Medial-only palatoplasty was associated with better preservation of palatal tissue oxygenation than lateral incision palatoplasty. In complete cleft palate, ∆StO 2 % at the hard and soft palate differed between incision designs, with medial-only incisions showing values closer to controls. In unilateral cleft lip and palate, lateral incisions reduced ∆StO 2 % at most sites compared with controls, with the greatest reduction in the non-cleft hard palate, whereas medial-only incisions were comparable to controls. No consistent association was identified between palatal index and ΔStO₂%. Perioperative complications were rare, and fistula rates were similar between incision designs. Conclusion Palatal tissue oxygenation varied by cleft type and incision design. Medial-only palatoplasty was associated with better preservation of palatal tissue oxygenation, identifying incision design as a modifiable surgical factor associated with tissue perfusion during cleft palate repair. ClinicalTrials.