In this study, we developed a three-dimensional finite element model of a cleft palate to analyze deformation and tension at common surgical incision sites used in reconstruction surgery. Our findings reveal critical insights into tension and deformation patterns, particularly identifying several key points along the suture on both the oral and nasal surfaces that exhibit the highest levels of tension and deformation. Reference values are applied by taking into account values defined in previous studies. The biomechanical properties of human skin are complex, and characterized by nonlinearity, viscoelasticity, and anisotropy, among others [23]. The mechanical properties of linear elastic materials are often characterized by measuring Young’s modulus [25]. A finite element model of unilateral cleft lip nasal deformity was conducted by Huang and his team, based on MRI (magnetic resonance imaging) data from one volunteer, including several cartilage frameworks and a skin envelope [24]. The direction of loading points and forces in the study was also selected according to experience, and the peripheral nodes of the model were set as fixed nodes. This Narrows down the possible range of surgical options. Akdemir et al. evaluated the maxillofacial stress distribution in patients with unilateral cleft lip and palate after different maxillary advancement schemes [26]. The results of this study provide information on the initial stress distribution and displacement patterns during maxillary extension in patients with cleft lip and palate, but because the soft tissue and postoperative scar tissue of cleft lip and palate were not considered in the modeling process, the actual treatment results may be different. However, our model provides a more nuanced understanding of tension distribution, indicating that this area is particularly susceptible to increased stress during surgery. This insight can inform surgical decisions, suggesting that greater care should be taken when operating in high-tension regions to minimize complications. When comparing our results with previous research, we note that traditional surgical techniques, such as Von Langenbeck palatoplasty, involve incisions made parallel to the fissure and gingiva (see Fig. 5) [7, 26]. Our findings align with earlier studies that highlight tension at the medial root of the cleft palate as a significant concern.

Major surgical procedures for cleft lip and palate. A Illustration of two-flap palatoplasty technique. B Illustration of Furlow palatoplasty. C Illustration of Von Langenbeck palatoplasty

Our analysis of the two-flap palatoplasty technique, which involves creating two flaps along the suture and stitching them together (see Fig. 5A) [10], suggests a potential improvement in surgical outcomes. Our findings can guide surgeons to identify a more optimal fold-over point at the middle suture, where deformation values are relatively lower, thereby potentially reducing the risk of postoperative complications.

Furlow palatoplasty, which utilizes two relaxed incisions to mitigate high incision tension (see Fig. 5B) is supported by our findings. The deformation data indicate that this technique may significantly enhance healing outcomes by minimizing stress at critical points during recovery. By highlighting these techniques and their implications for surgical practice, our study contributes valuable insights that could inform clinical strategies for cleft palate repair.

The use of 3D finite element analysis in cleft palate surgery offers several distinct advantages. This method allows for the simulation of complex mechanical behaviors, enabling visualization of stress distributions in multiple dimensions and more accurate predictions of surgical outcomes. Compared to traditional two-dimensional models, our 3D approach provides a comprehensive understanding of how various surgical techniques impact the palate’s biomechanical properties.

However, previous research in 3D modeling for cleft palate surgery has faced limitations, such as oversimplified assumptions regarding material properties or inadequate representation of tissue interactions. However, parameters such as cartilage size and skin depth are challenging to obtain in practice and vary significantly across a large cohort. Moreover, their use leads to extensive computation, delaying the production of patient models and the formulation of operation management strategies.

Furthermore, the 12 key points in our study determined based on potential surgical incisions, are not fixed and could vary, leading to some inevitable deviations in results. While the finite element model is a valuable tool, key factors such as nonlinear tissue properties, patient-specific anatomical differences, and long-term effects of surgical intervention should be adequately considered.

Addressing these limitations, as well as future directions like the use of more advanced material properties or clinical validation, would provide a more balanced assessment of your model's clinical applicability. We anticipate that future advancements in material properties and the integration of artificial intelligence will help overcome these challenges.