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ostectomy and not osteotomy for difficult cleft palate
this is a complicated procedure used only some maestros in the art
when a cleft palate is too wide,it will be impossible to get a tension free closure of the mucoperiosteal flap even with neuro vascular bundle release
the only way to get a tension free closure is a guarded postero medial , distal palatal ostectomy (demonstrated by my mentor Prof John Mulliken of Childrens Boston) where he uses a fine neurovascular guard and removes a small wedge of palatal bone
the flaps fall in the centre as a result
