Lingual pressure during dingman-assisted cleft palate repair: An investigatory case series

Background: A variety of palatoplasty techniques are used for cleft palate repair, almost all involving a device called the Dingman- Grabb mouth gag (“Dingman”) to push the tongue and cheeks out of the way of the operating field. There have been numerous case reports of complications hypothesized to be due to the gag, such as lingual edema and airway obstruction. The purpose of this study is to introduce a technique for monitoring lingual pressure during Dingman-assisted palatoplasty and present preliminary data from a small series. Methods: Patients with a cleft palate who underwent palatoplasty with the assistance of a Dingman-Grabb retractor at the Mount Sinai Hospital were eligible. Patients underwent a palatoplasty while having their lingual pressure monitored using a 23-gauge needle inserted into the tongue and connected to a pressure monitor. Results: Three patients were included. Patients 1 and 2 experienced a rapid rise in lingual pressure over the course of the first 45 minutes of the palatoplasty before plateauing until the conclusion of the operation when the Dingman was released. Patient 3 plateaued almost immediately by minute 1 and then had a rise in lingual pressure during the latter half of the operation, reaching a peak pressure immediately before the end of the operation. Conclusions: The present study describes an easy method to monitor lingual pressure that succeeded in measuring such changes throughout 3 palatoplasties and confirming the acute rise in lingual pressure and the potential danger posed to the tongue and the airway through the use of the Dingman.