Effects Of Using Gelatin Sponge In Cleft Palate Repair

Abstract

Cleft palate, a prevalent craniofacial anomaly, presents significant challenges in feeding, speech, and hearing for affected individuals. Surgical repair, or palatoplasty, aims to restore normal anatomy and function while minimizing complications. Despite advancements, postoperative issues such as oronasal fistula, hemorrhage, and wound dehiscence remain considerable concerns. This study investigates the efficacy of incorporating gelatin sponge as a third layer in Von Langenbeck cleft palate repair to mitigate these complications and improve overall healing outcomes. Cleft palate is a common congenital anomaly affecting approximately 1 in 2000 live births globally, with over 3,000 new cases estimated annually in Egypt alone.The condition imposes substantial emotional and societal burdens, necessitating comprehensive surgical and rehabilitative interventions. The primary objective of palatoplasty is to achieve anatomical closure of the palatal defect, facilitate normal speech development, minimize maxillary growth interference, and enable proper feeding and hearing. However, the rich vascular supply of the palate and the inherent tension in surgical closures contribute to a notable incidence of complications. Postoperative hemorrhage, ranging from 1.8% to 5.5%, and oronasal fistulae (ONF), with reported incidences up to 40%, are particularly challenging, often requiring secondary interventions and impacting patient quality of life. Wound dehiscence also poses a significant risk, compromising the integrity of the repair. Gelatin sponges, known for their biocompatibility, resorbability, and hemostatic properties, have been explored in various surgical fields to control bleeding and promote healing. This research hypothesizes that the strategic placement of a gelatin sponge as an interposition layer in Von Langenbeck palatoplasty can provide mechanical support, enhance hemostasis, and create a

more favorable environment for wound healing, thereby reducing the incidence of common postoperative complications. Participants were randomized in a 1:1 ratio into two groups: • Control group (n=10): Underwent standard Von Langenbeck palatoplasty without the application of a gelatin sponge. • Study group (n=10): Underwent Von Langenbeck palatoplasty with the adjunctive use of a sterile, absorbable gelatin sponge placed as a third layer between the closed nasal and oral mucosal layers, covering the raw bony surfaces of the hard palate. The study demonstrated a clear trend towards reduced complications and significant improvements in several surgical and recovery parameters in the gelatin sponge group, although statistical significance for primary outcomes was limited by the small sample size. In the gelatin sponge group, there was no patient developed a postoperative fistula and percentage (10%) demonstrated low level value that can be given to make statistical analysis with significance and to be correct , also there is no instances of hemorrhage or wound dehiscence. Conversely, the control group experienced a higher incidence: three patients (30%) with fistula formation, one (10%) with hemorrhage, and two (20%) with wound dehiscence. The single fistula in the gelatin sponge group was attributed to patient non-compliance with postoperative care due to familial and financial issues. Statistically significant improvements were observed in all secondary outcomes favoring the gelatin sponge group. Mean operative time was 12 minutes shorter, intraoperative blood loss was significantly reduced, and hospital stays were notably shorter. Furthermore, the wound healing score was significantly higher in the gelatin sponge group, indicating superior healing. No allergic or inflammatory reactions were reported, and parents reported higher satisfaction due to faster recovery and less feeding difficulty.