Clinical evaluation 3 years after modified unified velopharyngoplasty in patients with cleft palate and congenital velopharyngeal insufficiency

Abstract

ObjectiveWe have used modified unified velopharyngoplasty (mUVP) with mucosal palatal flaps for cleft palate and congenital velopharyngeal insufficiency (VPI) in 88 patients since 1996. This surgical method is reasonable from a functional point of view in that the levator veli palatini muscle is sutured to the pharyngeal constrictor muscle at both sides of the base of the pharyngeal flap. However, long-term outcomes remain inadequate because this is still a new surgical technique. We thus evaluated surgical complications and improvement in velopharyngeal closure (VPC) of our method. MethodsIn total, 88 patients (median age 7.5 years; age range 3.5–40 years) who underwent mUVP by the same operator were followed up for more than 3 years after surgery. Surgical invasiveness, such as blood loss volume, operative time, and operative complications, was assessed in all 88 patients. Preoperative and postoperative VPC and impaired articulation were assessed in 65 of the 88 patients. ResultsNo surgical complications including marked blood loss occurred. Postoperative improvement in VPC after mUVP was achieved in 85 % of cases at 1 year after surgery and in 98 % at 3 years. No relapse of VPI was found during the follow-up period. However, the postoperative outcomes varied by cleft type, age at surgery, and presence of intellectual disability. ConclusionmUVP is safe and useful to improve VPI. Preoperative fiberscopic evaluation is important to obtain satisfactory outcomes. Speech therapy and assessment should be continued for at least 3 years after surgery.