Clinical Outcomes of Primary Palatal Surgery in Children with Nonsyndromic Cleft Palate with and without Lip.

Seunghee Ha,Seungeun Jung,Heewon Moon,Tae Suk Oh,Kyung S Koh

doi:10.1155/2015/185459

Seunghee Ha, Seungeun Jung + Show 3 more

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https://doi.org/10.1155/2015/185459

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Abstract

This study presents clinical outcomes of primary cleft palate surgery, including rate of oronasal fistula development, rate of velopharyngeal insufficiency (VPI) requiring secondary surgery, and speech outcomes. We examined the effect of cleft type on the clinical outcomes. Retrospective analysis was performed using clinical records of all patients who received a primary palatoplasty at the Cleft Palate Clinic at Seoul Asan Medical Center, South Korea, between 2007 and 2012. The study included 292 patients with nonsyndromic overt cleft palate (±cleft lip). The results revealed that the rate of oronasal fistula was 7.9% and the incidence of VPI based on the rate of secondary palatal surgery was 19.2%. The results showed that 50.3% of all the patients had received speech therapy and 28.8% and 51.4% demonstrated significant hypernasality and articulatory deficits, respectively. The results of the rate of VPI and speech outcomes were significantly different in terms of cleft type. Except for the rate of oronasal fistula, patients with cleft palate generally exhibited better clinical outcomes compared to those with bilateral or unilateral cleft lip and palate. This study suggests that several factors, including cleft type, should be identified and comprehensively considered to establish an optimal treatment regimen for patients with cleft palate.

Highlights

Cleft palate is the most common type of innate craniofacial anomaly, which requires multidisciplinary treatment approach, including physical palatal correction, feeding management, orthodontic management, and speech-language services
Over the past several years, advances have been made in surgical management of cleft palate in terms of surgical techniques and timing of palatal surgery [1,2,3,4,5], which has decreased the postoperative rate of oronasal fistula, decreased the rate of persistent velopharyngeal insufficiency (VPI), and improved speech outcomes
This study focused on three postoperative outcomes, the rate of oronasal fistula and the rate of VPI based on the percentage of secondary palatal surgery as well as speech outcomes related to hypernasality and articulatory proficiency

Summary

Introduction

Cleft palate is the most common type of innate craniofacial anomaly, which requires multidisciplinary treatment approach, including physical palatal correction, feeding management, orthodontic management, and speech-language services. Over the past several years, advances have been made in surgical management of cleft palate in terms of surgical techniques and timing of palatal surgery [1,2,3,4,5], which has decreased the postoperative rate of oronasal fistula, decreased the rate of persistent VPI, and improved speech outcomes. Surgical palatal techniques have focused on a proper muscle repair (e.g., Furlow double-opposing Z-plasty), and the timing of palatal surgery has dramatically decreased from 18–24 months before the 1980s to 9– 12 months in the present [6]. These changes in surgical management of cleft palate have led to improved clinical outcomes

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