The Double Palatal Graft: A Novel Management of Severe Vertical and Horizontal Soft Tissue Deficiency

Management of a severe soft tissue defect in the anterior esthetic zone is challenging, especially when associated with a palatal cleft. This case report describes a novel technique to augment soft tissue thickness and height with a procedure that combines two different soft tissue grafting techniques in one step. Case Presentation A patient presented to the author's private practice with a unilateral cleft lip and palate with a severe vertical and horizontal soft tissue deficiency at the cleft site. Double graft was used to correct the soft tissue defect in one session; one as a pedicle harvested from the palate close to the defect, and the other as a partially de‐epithelialized free graft harvested from the other side of the palate. Both grafts were sutured overlying each other as a double graft. The pedicle graft was sutured at the base of the labial flap, whereas the partially de‐epithelialized free graft was adapted to the recipient site, which included labial and palatal pouches, overlying the pedicle. After 3 months, clinical outcome exhibited favorable results in the form of ample gain in both volume and quality of the soft tissue, restoration of the level of the mucogingival junction, and closure of the palatal cleft. Conclusion The technique described in this case report could be considered as a method to augment soft tissue volume and quality prior to hard tissue augmentation in severe soft tissue defects.