INTRODUCTION
In cleft surgery, there has been significant progress in repair technique. However, the surgical site environment has not kept up with this technical progress. This gap between technique and the environment has a significant impact on efficiency. A suturing environment with the Dingman mouth gag can be obstructive and inconvenient. Many cleft surgeons have had no choice but to work with this inconvenience.
IDEA
We introduced a simple but effective drape method for cleft palate surgery. The concept is quite simple. Patients were draped in the usual manner. When the flap dissection was over and the repair remained to be done, a soaked disposable hand towel was placed over the Dingman mouth gag site. A hole matching the mouth was made on the towel. After making the hole, it was dipped in water again and gently wrung. The hole was placed over the mouth and water was dripped onto the towel surrounding the hole. During suture, this wetting helped keep the towel in place (Figs. 1, 2).
We applied this draping technique over the Dingman mouth gag for every cleft palate surgery from 2012 to 2013. The total number of cases was 26. The average operation time was reduced to 89 minutes, 14 minutes less than the previous average of 103 minutes in operations from 2010 to 2011. This indicates that cleft surgery was performed under more favorable circumstances.
DISCUSSION
The Dingman mouth gag is popular in many cleft palate and intraoral surgeries for several reasons. The surgical field of oral surgery is very narrow and deep; hencethe gag has played an important role in opening and maintaining the intraoperatively-opened field. The gag is especially useful when fixed in place for oral surgery. Although many cleft surgeons have tried to create a better environment by modifying the gag, these efforts were limited to improving stability or adding a light source to there tractor itself. Our method is simple but applicable to any modified gag setup[1,2,3,4,5].
There are several advantages to this method. First, it can prevent suture material from being caught in the gag. Repair is the last very important procedure in cleft palate surgery. Long operations lead to surgeon fatigue. A tired surgeon is easily annoyed by small, unimportant events, such as caught suture material. Repetition of these minor incidents results in diminished concentration and poorer results. Second, it may reduce suture material-associated infection. Despite a facial drape on the cleft patient, there is no definite barrier between the aseptic and septic condition. Because the surgeon must focus on repair, the suture material is not given much attention. Prolonged duration of repair increases the possibility of contamination. In addition to a septic conditions, cleansing suture material becomes much easier. Third, the surgeon can retain focus on the operation field. A simple circular visual field that excludes vision outside the circle facilitates this. Furthermore, warm temperature is essential to pediatric operation. Dripping water on the towel decreases the temperature around the field. The surgeon finds this procedure refreshing.
Cleft palate surgery is a sophisticated operation. It requires the keen ability of a surgeon to focus on the operation. This simple draping compensates for the many disadvantages of this encumbered space. We evaluated the operation time only, but expect that results can also be improved.