Subperiosteal early resection of the mid-palatal suture. A morphological study in twelve patients operated for choanal atresia.

Twelve patients with choanal atresia were operated on by a method which involves a subperiosteal resection of the hard palate including the posterior two-thirds of the mid-palatal suture. In 7 patients, admitted for reoperation, peroperative examinations revealed an osseous defect in the posterior part of the hard palate. Biopsies showed that repair in this area was mostly by connective tissue, indicating that formation of new bone, regenerated from periost, is minimal in this part of the palate. Fresh specimens from 5 previously unoperated patients and from the anterior intact part of the palate of the reoperated patients, displayed that the mid-palatal suture was not obliterated even at 26 years of age. Longitudinally orientated intrasutural fibres and signs of active growth were evident up to puberty. The suture seemed to consist of three layers.