Abstract
BackgroundThe cause of maxillary growth restriction in patients with cleft lip and palate remains controversial. While studies have investigated the effects surgical technique and timing have on maxillary growth, few focus on patients with isolated cleft palate (ICP). The purpose of this study was to determine the impact palate repair and its associated complications may have on maxillary growth.MethodsA retrospective chart review of ICP patients who underwent palatoplasty from 1962 to 1999 at Akron Children’s Hospital was performed. Patient demographics, Veau type, age at primary repair, closure technique, presence of fistula or velopharyngeal insufficiency (VPI), number of palatal operations, maxillary hypoplasia (MH) frequency, and follow-up were recorded. Exclusion criteria included patients with cleft lip, submucous cleft, or syndromes.ResultsTwenty-nine non-syndromic ICP patients were identified; 62% (n = 18) had Veau type 1 and 38% (n = 11) had Veau type 2. All patients underwent 2-flap or Furlow palatoplasty with mobilization of mucoperiosteal flaps. Vomerine flaps were used in all Veau 2 cleft palate closures. Palatoplasty was performed at a mean age of 19.9 ± 8.2 months. Average follow-up was 209 ± 66.5 months. The rate of VPI was 59% (n = 17) and the rate of oronasal fistula was 14% (n = 4).ConclusionsThere was a low incidence of MH despite complications after initial palate closure. Our results seem to suggest that age at palate closure, type of cleft palate, and type of surgical technique may not be associated with MH. Additionally, subsequent procedures and complications after primary palatoplasty such as VPI and palatal fistula may not restrict maxillary growth.
Highlights
The cause of maxillary growth restriction in patients with cleft lip and palate (CLP) remains controversial
We exclusively reviewed isolated cleft palate (ICP) patients with Veau types 1 and 2 that underwent surgical repair in our study to determine factors associated with maxillary hypoplasia (MH)
Multiple surgeons were involved in our study, and in spite of varied techniques, and differing results in terms of fistula and velopharyngeal insufficiency (VPI), the variability did not seem to contribute to maxillary growth in ICP
Summary
The cause of maxillary growth restriction in patients with cleft lip and palate (CLP) remains controversial. Other authors believe that palatoplasty contributes to this phenomenon as numerous reports have noted normal maxillary growth in nonoperative CLP patients [4,5,6,7,8,9]. This has led to numerous studies that investigated the effects of surgical technique and timing have on maxillary growth. While studies have investigated the effects surgical technique and timing have on maxillary growth, few focus on patients with isolated cleft palate (ICP). The purpose of this study was to determine the impact palate repair and its associated complications may have on maxillary growth
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