Primary Palatal Surgery in Nonsyndromic Cleft Palate Children and Velopharyngeal Insufficiency Correction Outcomes.

Abstract

Speech has a very significant impact on the life quality of people with cleft and lip palate. Restore tissue anatomy and functionality is the main aim of primary palatal surgery. Multiple factors are associated with successful handling, including the need for a velopharyngeal insufficiency (VPI) secondary surgery. The study's aim is to determine speech and velopharyngeal function outcomes in children with cleft palate operated in our institution and to determine VPI secondary surgery outcomes, if appropriate. Clinical records of nonsyndromic patients with cleft palate born between January 2009 and December 2012, who performed their multidisciplinary care on our institution, were analyzed retrospectively. One hundred forty-two patients received primary palatal surgery. Eighty (56%) were male and 62 (44%) female. Twenty-two had soft cleft palate, 9 hard and soft cleft palate, 84 unilateral, and 27 bilateral cleft lip and palate. Twelve percent of patients presented palatal fistula, with a significantly higher presentation in Soft Cleft Palate and Hard and Soft Cleft Palate. Twenty-seven patients (19%) had surgical indication for VPI correction, and 20 of them received VPI surgery, before school age. Cleft type and gender were significantly associated with VPI surgery indication rate. Postsurgery, 80% presented normal resonance. Nasal emission improved in 85% of patients. Nasometry decreased from 45% to 31%. Hyponasality increased by 10%. One case presented total flap dehiscence. Preoperative planning must be done carefully and individualized to succeed. Future prospective research that considers all the variables for a correct analysis is advisable, to improve our results.