Application of Hand Towel Drape over Dingman Mouth Gag

Closure of the Nasal and Buccal Layers in V-Y Pushback Palatoplasty: Use of a Spring Carrier

The aim of this paper is to re-introduce Kilner and Calnan's technique of closing the nasal and buccal layers in V-Y pushback palatoplasty by using the spring carrier on the mouth gag.After flap elevation and dissection, the first suture is inserted through the nasal layer of the mucosa at the level of the posterior border of the hard palate. This 3-0 stitch is left untied until later. The nasal layer is approximated by inserting a series of 4-0 sutures so that the knots can be tied on the mucosal surface inside the nose. All sutures are inserted before any are tied. The sutures are inserted consecutively, moving from the hard palate region toward the uvula. The sutures may be held on the spring suture carrier attached to the mouth gag; they should be covered by a damp swab. When all sutures have been inserted, they are then tied firmly with three knots, working from behind to forward, and cut short by the surgeon. The buccal layer is closed starting from the uvula and moving toward the hard palate. A series of interrupted mattress sutures are inserted to unite the mucosa and the velar muscles. The inserted sutures are tied before the next stitch. They may be cut by the assistant, leaving 3 to 4 mm beyond the knot.In this technique, the untied sutures could be arranged well on the spring suture carrier attached to the mouth gag. When covered by a damp swab, the catgut sutures did not dry up.