Two-stage cleft palate closure by our treatment algorithm in complete unilateral cleft lip and palate: Results of velopharyngeal function

Abstract

ObjectiveIt has been reported that two-stage palatoplasty is excellent in terms of maxillary growth but poor in terms of speech outcomes. We modified the two-stage Zurich approach in two aspects. First, the speech plate is placed immediately after soft palatoplasty using Perko’s technique to prevent air leakage through the nose in all cases. The other is that simultaneous closure of the alveolar and hard palate cleft with bone grafting is delayed until age ≥8 years to allow maxillary growth. In this paper we report on postoperative velopharyngeal function and role of the speech plate. MethodsWe investigated velopharyngeal function in 30 consecutive complete unilateral cleft lip and palate patients in three phases (A, B, C): Phase A, at age 5–6 years; Phase B, immediately before simultaneous hard palate closure with alveolar cleft bone grafting; and Phase C, after complete closure of the alveolar and hard palate cleft. ResultsVelopharyngeal function was 83% in phase A, 97% in phase B and 100% in phase C. Three patients underwent pharyngeal flap surgery before phase B. All patients could use speech plates. Speech plate placement earlier after soft palatoplasty produces better velopharyngeal function at age 5–6 years. ConclusionsWe obtained the same success rate as other palatoplasties such as pushback or Furlow’s technique in terms of velopharyngeal function, demonstrating the importance of early speech plate placement.