Radical overlapping intravelar veloplasty during primary cleft palate repair results in decreased secondary speech surgery.

Abstract

There is growing evidence that performing a radical intravelar veloplasty (IVV) improves speech outcomes. The aim of this study was to determine the impact of a radical IVV during primary palatoplasty on the rate of secondary speech surgery. This is a retrospective review of primary palatoplasty using an IVV performed by a single surgeon from the year 2000 to 2023. In 2008, the surgeon changed technique to involve a more radical IVV. The radical overlapping IVV involves release of the palatopharyngeus from the posterior hard palate and from the nasal component of the tensor veli palatini, release of the levator veli palatini to the levator tunnel, and overlapping of the palatopharyngeus-levator unit across the midline after retro-positioning. This separated the patients into a before and after technique change group. The rate of secondary speech surgery was compared between the two time periods. An IVV was performed during straight line repairs 333 and 272 times during the first and second time periods, respectively. The second radical overlapping IVV group had significantly (p<0.05) less secondary speech surgery procedures at 43 (15.81%) compared to 83 (24.92%) amongst the first conservative IVV group (p<0.05). Precise anatomical dissection, extensive release, retro-positioning and overlap of the velar musculature during IVV results in significantly less secondary speech surgery.