Keywords
Primary palate, orofacial clefts, oronasal fistula, congenital defect, developmental abnormality

 Clefts of the primary palate are defects in the structures of the primary palate, the upper lip and the incisive bones rostral to the palatine fissures. During embryological development, the paired maxillary processes merge with the medial and lateral nasal processes, forming the nose, upper lip and incisive bone.1 Failure of these structures to completely merge results in developmental clefts of the primary palate. The basis of surgical intervention in cases of cleft lip and palate involve the separation of the nasal and oral cavities to allow normal physiologic processes such as suckling and alimentation. Surgical principles of cleft palate surgery include gentle tissue handling, avoiding tension on the suture line, preservation of blood supply, avoiding placing sutures directly over a bony defect, developing appropriately sized flaps and avoidance of electrocautery. In general, the best chance of surgical repair is on the first attempt. A variety of techniques for repair of clefts of the primary palate have been reported, but surgical intervention has been described as challenging.1 Staged, double-layer closure of challenging defects of the secondary palatal has previously been successfully reported in dogs.2 Variations of this technique may also be useful for the closure of wide clefts of the primary palate. This presentation will discuss techniques for closure of congenital clefts of the primary palate, with a particular emphasis of a novel, staged technique for closing wide, bilateral defects of the primary palate including salvage excision of the incisive bone.

References
1 Fiani N, Verstraete FJM, Arzi B. Reconstruction of congenital nose, cleft primary palate, and lip disorders. Vet Clin North Am Small Anim Pract 2016;46(4):663-75. doi: 10.1016/j.cvsm.2016.02.001
2 Peralta S, Nemec A, Fiani N, Verstraete FJM. Staged double-layer closure of palatal defects in 6 dogs. Vet Surg 2015;44(4):423-31.doi: 10.1111/j.1532-950X.2014.12131.x