Costal Cartilage Chip Grafting for High-Arched Narrow Palate Deformity Secondary to Palatal Bone Fracture.

Abstract

Palatal bone fractures are often associated with vertical maxillary fractures, but direct reduction of the palatal bone itself is rarely performed. We report a case in which a high-arched narrow palate deformity following palatal bone fracture associated with multiple facial fractures was successfully corrected by grafting costal cartilage chips to the hard palate. The patient was a 25-year-old man. At the age of 19, he sustained a cervical spinal cord injury at the C4 level and multiple facial fractures-including maxillary fracture with zygomatic and palatal bone fractures, as well as mandibular fracture-due to a traffic accident. Open reduction of the facial fractures was performed at another hospital. During follow-up at our institution, he complained of food accumulation in the depression of the hard palate caused by the palatal fracture and requested treatment. Although he could take food orally, cervical spinal cord injury had resulted in restricted tongue mobility and complete paralysis below the neck, making removal of food residues with his tongue or hands difficult. Intraoral examination revealed a reverse V-shaped depression of the palate, consistent with a high-arched narrow palate deformity. Surgery was performed by elevating a mucoperiosteal flap of the hard palate, slicing costal cartilage harvested from the 7th rib into chips, and grafting them into the depressed area of the hard palate. At 3 years postoperatively, the depression of the hard palate had markedly improved, and no food retention was observed. In general, deformities of the hard palate resulting from palatal bone fracture rarely cause functional impairment, and few reports of surgical treatment exist. In this case, we achieved a favorable outcome for a chronic high-arched narrow palate deformity using costal cartilage chip grafting. Costal cartilage chips, which are also used in the treatment of old orbital fractures with enophthalmos, offer advantages such as balanced and adjustable filling of depressed defects and low resorption compared with bone or soft tissue grafts. This method appears to be a useful surgical option for symptomatic high-arched narrow palate deformities.