Early Cleft Palate Repair Research Articles

Early Cleft Palate Repair is Associated With Lower Incidence of Velopharyngeal Insufficiency Surgery.

The timing of primary repair in nonsyndromic cleft palate remains controversial. Recent evidence suggests earlier repair is associated with a lower incidence of velopharyngeal insufficiency (VPI). The authors aim to evaluate these findings in a large cohort study using causal inference. All nonsyndromic cleft palate repairs in California were extracted between 2000 and 2021 from the California Health Care Access and Information (HCAI) database. Cases were linked with VPI surgery following cleft palate repair based on unique identifiers. The main outcome measure was incidence of VPI surgery evaluated with propensity score matching. Early cleft palate repair was defined as <7 months of age versus traditional cleft palate repair at >11 months of age. Standardized mean differences (SMD) were measured before and after matching for potential confounders including sex, race, payer, and distance from patient home to hospital. In all, 52,007 cleft palate repairs were included, of which 12,169 (23.3%) were repaired early and 39,838 (76.7%) were repaired traditionally. Early cleft palate repairs underwent VPI surgery in 1.2% (13/1,000) of cases, compared with 6.1% (61/1000) in the traditional repair cohort. Post-matching, the average treatment effect of early repair was a 6.3% reduction in VPI surgery (P<0.001, 95% CI -6.3, -5.4%). All covariate SMDs were <|0.1| after matching. Our cohort study demonstrates a significantly reduced incidence of VPI surgery in children with primary cleft palate repair <7 months of age. Craniofacial centers should consider early cleft palate repair in appropriate patients.

Minimally-invasive airway management and early cleft palate repair in infants born with Robin sequence

The objective of this study was to report outcomes of early cleft palate repair in infants born with Robin sequence (RS). A retrospective case series in a tertiary referral paediatric hospital was carried out, examining a consecutive series of 69 infants born with RS and cleft palate. A minimally invasive approach was taken to upper airway obstruction, with liberal nasopharyngeal airway (NPA) and non-invasive ventilation (NIV) use, guided by sleep studies. The palate was repaired between 6 and 9 months with a modified Malek technique. The most frequently used airway adjunct (59.4% of patients) was an NPA and the median duration of use was 5.6 months. All patients underwent a modified Malek cleft palate repair at a median of 7 months of age. Overnight oximetry demonstrated higher mean oxygen saturation (SpO2) across the group from initial neonatal admission to discharge (median 96.5% (interquartile range [IQR] 95–98%) vs 97.45% (IQR 96.5–98%) (P = 0.2, N = 34). Of those with a cardiorespiratory polysomnogram, the obstructive apnoea-hypopnea index (OAHI) was significantly lower postoperatively (5.9 vs 2.8, P = 0.028). This study supports the use of non-surgical airway strategies and early cleft palate repair in infants born with RS and cleft palate.

Early Cleft Palate Repair by a Modified Technique Without Relaxing Incisions.

This study sought to evaluate a modified palatoplasty technique (MPT) concerning the postoperative outcomes and associated influencing factors. A retrospective cohort study. One hundred forty-three consecutive patients with non-syndromic cleft palate, who received MPT before one year of age within an oral and maxillofacial surgery department of a university-affiliated tertiary hospital between 2011-2017, were reviewed. The postoperative wound healing and velopharyngeal function (VPF) were the primary outcome measures. The sex, age at surgery, cleft type, cleft width, palatal width, soft palate length, pharyngeal cavity depth, and operation duration were preselected as influencing factors. Univariate and multivariate analyses were conducted. The mean age at surgery was 9 ± 1.31 months (5-11), and the average cleft width was 9.03 ± 2.41 mm (4-15). The rate of incomplete cleft palate was 84.6% while the complete cleft palate was 15.4%. Complete wound healing was reported in 96.5% while the others (3.5%) had persistent oronasal fistula. About 90.2% of cases have shown normal velopharyngeal function whereas the others (9.8%) had sustained velopharyngeal insufficiency. The wound healing appeared to be significantly impacted by cleft width and pharyngeal cavity depth (P = .015 and 0.049, respectively). However, none of the factors had a significant association with VPF. The present modified palatoplasty technique has obtained a low fistula rate and appropriate speech outcome. Therefore, this MPT could be promoted for early repairing cleft palate of different severities.

Does early cleft palate repair make difference? Comparative evaluation of the speech outcomes using objective parameters

The present study aims to evaluate the effect of timing of cleft palate repair on speech results by using objective assessment tools, under standardized variables. The patients included in the study were divided into three groups according to their age of palatal repair. Velopharyngeal closure was evaluated anatomically by nasopharyngoscopy, and the nasalance values were recorded and evaluated objectively by nasometer. Also, the rate of secondary surgical intervention and fistula rate was analyzed for each group. Nasalance values and nasopharyngoscopic evaluation results were statistically similar between group 1 and group 2. However, there was a statistically significant difference between these groups compared with group 3 in the nasalance value of all speech samples and terms of the velopharyngeal complete closure (p = 0.022). The rate of fistula and secondary surgical intervention was statistically similar between the groups (p = 0.080). In secondary surgical intervention rates, the difference between group 1 and group 3 was statistically significant (p = 0.016). The present study confirms the importance of the 18th month as a cut-of time in palatal repair for improved speech results by using objective assessment tools.

Velopharyngeal Closure and Resonance in Children Following Early Cleft Palate Repair: Outcome Measurement.

Introduction Timing of cleft palate repair and the method of speech outcome measurement in children with cleft lip and palate are much debated topics. The associated problems and quality of life in these children depend on the timing of the surgery. Aim The aim of this study was to investigate the velopharyngeal (VP) function and resonance parameters in children following early cleft palate repair. Method A total of 25 Kannada-speaking children with early repaired cleft palate were subjected to speech assessment and videofluoroscopic assessment. Perceptual speech parameters measured were severity of hypernasality and presence of nasal air emission. Videofluoroscopy was interpreted in terms of closure ratios to predict the severity of VP dysfunction. Results The analysis of videofluoroscopic images indicated that 48% of children had complete VP closure and 52% had perceptually normal resonance. A good correlation was found between the closure ratio and hypernasality. Conclusion Understanding the perceptual speech parameters and their structural correlates for outcome measurement will give better evidence for refining the existing treatment protocols. Data on a larger population are warranted for establishing predictors of optimum speech outcome.

Maxillary growth in patients with complete cleft lip and palate, operated on around 4–6 months of age

Background The controversy about timing of cleft palate repair has been focused on early closure for improved speech versus delayed repair for enhancing maxillary growth. Early palatal repair enhances phonological development decreasing the frequency of articulation disorders associated with velopharyngeal insufficiency (VPI). In contrast, it has been described that early surgery adversely affects maxillary growth. Objective The purpose of this paper is to study maxillary growth in a group of cleft palate patients operated on around 4–6 months of age, and receiving further orthodontic treatment. Materials and methods A group of 20 cleft palate patients, who were subjected to early minimal incision palatopharyngoplasty around 4–6 months of age, were followed for a minimum of 10 years (range: 10–14 years). All patients received the same orthodontic management, starting at 4 years of age. None of the patients had orthognatic surgery or alveolar bone grafting. After orthodontic treatment, their cephalometric data were compared with a group of subjects without cleft lip and palate, matched by gender and who were within the age range of the cleft palate group. Results SNA, SNB, ANB, and WITS cephalometric measures were compared. A non-significant difference was found in all measurements between the two groups. Conclusion Early cleft palate repair enhances phonological development. Although maxillary growth is affected in cleft palate patients, appropriate orthodontic treatment can achieve normal maxillary growth as measured during adolescence.

Audiological Status of Chinese Patients with Cleft Lip/Palate

To review the audiological and otoscopic status of Chinese children and young adults seen at a cleft lip and palate clinic in Hong Kong and compare with previous studies of Western clinical populations. The hearing health status of the patients was analyzed on the basis of the results of their otoscopic, pure tone audiometric, and tympanometric examinations. The patients' sex, age, race, and type of cleft pathology were examined for their potential relationship to hearing health status. The records of 180 predominantly Chinese patients attending the Cleft Lip and Palate Centre, Prince Philip Dental Hospital/University of Hong Kong from July 1977 to December 1999 were reviewed. The results indicated 13.4% of patient ears failed the audiometric screening and 23.7% of patient ears yielded abnormal tympanometric results. Patients' sex, age, and type of cleft pathology were found not to be related to hearing screening results. The prevalence of hearing disorder was in contrast with Western studies that show a much higher rate of audiological problems in children and young adults with cleft lip/palate. Racial factors were considered to be possible reasons for this disparity. Other factors, such as timely medical and surgical intervention, including early cleft palate repair and the insertion of ventilation tubes in cases of middle ear effusion, do not convincingly account for the study findings.

A method of "unilateral operation" for early repair of unilateral complete cleft palate. Preliminary report.

This article describes a method of "unilateral operation" and the preliminary results of a group of patients with unilateral complete cleft palate undergoing the operation at early age. The "unilateral operation" consists of four relaxation maneuvers. After all of the four maneuvers have been performed on the deformed side of an unilateral complete cleft palate, the deformed side can be moved posteriorly and medially to contact with the normal side. Then the cleft can be closed without tension. From 1995 to 1998, 19 cases of unilateral complete cleft palate were repaired with this method at 5-12 months of age. Postoperatively, there were no deaths nor dehiscences. Under the care and guidance of an experienced speech pathologist, 15 of 17 of these children have normal vocal quality at 1-2 years of age. The "unilateral operation" is a rational, adequate, and safe method for early repair of unilateral complete cleft palate. It's design addresses four principles. First, operating only on the deformed side of a unilateral complete cleft palate leaves the normal side unperturbed. Second, complete relaxation of the deformed side is achieved before closing the cleft. Third, in comparison with conventional procedures, which operate on both sides of the palate, this method has the advantage of less surgical trauma, less blood loss, and shorter time of operation. Fourth, all of these advantages are beneficial to early cleft palate repair, which is an important factor in achieving good speech.

Early cleft palate repair completed before the age of 16 weeks

Early cleft palate repair completed before the age of 16 weeks

The assessment of middle ear function and hearing by tympanometry in children before and after early cleft palate repair

The assessment of middle ear function and hearing by tympanometry in children before and after early cleft palate repair

The assessment of middle ear function and hearing by tympanometry in children before and after early cleft palate repair

Tympanometry has been carried out to assess middle ear function in cleft lip and cleft palate children from birth. All these children had normal aeration of the middle ear at birth, and remained normal until complications began to appear at 17 weeks. Closure of the palatal defect is known to reduce middle ear complications and its seems that closure at, or before, 4 months of age significantly reduces these complications.

Early cleft palate repair completed before the age of 16 weeks: observations on a personal series of 100 children

This paper is a review of a series of 100 children on whom the author carried out a cleft palate repair at or before they reached the age of 16 weeks. These children had tympanometry tests done before and after surgery. In the case of clefts of the primary and secondary palate, dental casts were taken. The author's personal technique of cleft palate repair is presented. Some of the early results are discussed along with thoughts on the effects on jaw development, speech and hearing of such early surgery.

Early cleft palate repair completed before the age of 16 weeks: observations on a personal series of 100 children

Early cleft palate repair completed before the age of 16 weeks: observations on a personal series of 100 children

Early Cleft Palate Repair and Speech Outcome

Early Cleft Palate Repair and Speech Outcome

Early cleft palate repair and speech outcome.

Speech production and age at palatal repair were investigated in 80 cleft palate children. Children whose palates were repaired prior to the onset of speech production demonstrated significantly better speech than those whose palates were repaired between 12 and 27 months of age. The supposition that earlier palatal repair results in more normal speech development was, in fact, demonstrated in these cases. Rather than using chronologic age alone as the deciding factor in determining timing of initial palatal repair, the stage of each child's phonemic development should be considered if maximum speech potential is to be achieved and if speech development is to parallel normal noncleft peers. Determining this stage of development through early speech and language evaluations, beginning at 6 months of age, thus becomes an essential component in the habilitation of children with cleft palate. Continued research is needed to ensure against giving the obtainment of early speech normalcy disproportionate emphasis over craniofacial growth considerations. To this end, continued cooperative research between surgeons and speech pathologists is imperative in order to base these important decisions on substantiated findings.