An 11-month-old cat presented for chronic nasal discharge (Figure 6) and a considerably large congenital soft palatal cleft (Figure 7). The bilateral cleft extended from the midline to just medial to the palatoglossal folds. Clefts of this type are often associated with additional signs of coughing, gagging and sneezing. Aspiration pneumonia is a common complication.
Figure 6: An 11-month-old domestic short-haired cat with chronic bilateral nasal discharge.
Figure 7: A bilateral congenital soft palatal cleft.
Repair of congenital clefts in young animals should ideally be delayed until the patient is at minimum 8 weeks of age. Many of these patients demonstrate mild to moderate clinical signs that can be managed until the ideal time of 16 weeks of age. Surgery at this time provides more tissue and an ideal blood supply for an excellent prognosis for complete closure.
The surgical approach requires patient positioning in dorsal recumbency. Mucus is often present (Figure 8) and evident upon positioning and should be removed with cotton tipped applicators. A thin muscular layer separates the oral and nasal palatal mucosa. A small stab incision is created at the rostral aspect on each side of the defect. Scissors are used to extend the separation of the oral and nasal mucosal layers to the caudal extent of the defect. Further lateral dissection allows for mobility of each layer enabling tension-free primary closure (Figure 9). The nasal layer is closed with simple interrupted sutures using 5-0 monocryl. The same suture material and pattern is then used to close the oral mucosa (Figure 10).
Figure 8: Mucus is present in the nasopharynx and is removed prior to surgery.
Figure 9: The nasal (black arrow) and oral (white arrow) mucosa following dissection to separate the layers prior to closure.
Figure 10: Simple interrupted sutures are used to close the nasal and the oral mucosa.
The primary concern with this defect was closure without tension due to the large size of the defect. Careful dissection and delicate tissue manipulation is required to minimize trauma and maintain blood supply to ensure full closure. This patient experienced a complete recovery with elimination of clinical signs (Figure 11).
Figure 11: Four weeks postoperatively shows complete closure of the defect.