Method Of Cleft Palate Repair Research Articles

The buccal fat pad and intravelar veloplasty

Introduction: We describe the use of the buccal fat pad flap in conjunction with the Sommerlad method of cleft palate repair.

Cleft palate repair with the use of osmotic expanders: a preliminary report

A new method of cleft palate repair by expansion of tissue by means of osmotic expanders implanted in the first stage of treatment is described. Self-expanding expanders manufactured by OSMED (Ilmenau, Germany) were implanted under the mucoperiosteal layer of the hard palate, on purpose to generate more tissue and provide facility for palate repair performed 24-48h later. Nineteen children aged from 2 to 3 years were operated from January 2004 to 15 April 2005. In clefts<10mm, tissue repair was possible without relaxing incisions. In 11 patients with clefts>10mm, cleft palate repair was more difficult and the outcomes were less favourable. Despite more generous dissection of the neurovascular bundles and other adjunctive measures such as mucosal V-Y plasty [Bardach J, Salyer K. Surgical techniques in cleft lip and palate. Chicago, London: Year Book Medical Publishers, Inc.; 1987.] and suturing of the mucosal grafts at the border of the hard and soft palate, seven 2-4mm fistulae were noted, however. Concluding, in spite of some shortcomings and unacceptable rate of fistula in wide clefts, the above-presented method seems to be an attractive concept. Despite some technical problems related mostly to still tested optimal filling phase, tissue expansion makes palate repair easier, probably without relaxing incisions and bone denudation. Consequently, some adverse effects on facial growth may be reduced. So far, there is no evidence for it, however, and since this is a preliminary report, there is a need for longer observations and larger material.

A Cephalometric Study of Facial Growth in van der Woude Syndrome

Abstract Objective: To test the hypothesis that maxillary growth and lower lip form in patients with van der Woude syndrome (VDW) is different from patients with nonsyndromic cleft lip and palate. Design and Setting: Retrospective, case-control study at a tertiary cleft center, Chang Gung Memorial Hospital, Taipei, Taiwan. Patients and Participants: Records of 53 patients with VDW, who presented for treatment during the years 1968 through 1998 were obtained. Twenty-three of 53 patients had received at least one lateral cephalogram during the course of their treatment. Of these 23, in 17 it was possible to find nonsyndromic case controls with identical cleft type, sex, and method of cleft palate repair, with year of birth matching within 1 year of the corresponding VDW patient. For these 17 pairs of VDW and nonsyndromic cleft controls, cephalogram acquisition dates were checked to see how well the corresponding pairs matched. A total of 43 pairs of cephalograms were deemed to be acceptably matched because ...

A Cephalometric Study of Facial Growth in van der Woude Syndrome

To test the hypothesis that maxillary growth and lower lip form in patients with van der Woude syndrome (VDW) is different from patients with non-syndromic cleft lip and palate. Retrospective, case-control study at a tertiary cleft center, Chang Gung Memorial Hospital, Taipei, Taiwan. Records of 53 patients with VDW, who presented for treatment during the years 1968 through 1998 were obtained. Twenty-three of 53 patients had received at least one lateral cephalogram during the course of their treatment. Of these 23, in 17 it was possible to find non-syndromic case controls with identical cleft type, sex, and method of cleft palate repair, with year of birth matching within 1 year of the corresponding VDW patient. For these 17 pairs of VDW and non-syndromic cleft controls, cephalogram acquisition dates were checked to see how well the corresponding pairs matched. A total of 43 pairs of cephalograms were deemed to be acceptably matched because the ages at acquisition differed by less than 15% of the VDW patient's age. Thirteen measurements were derived from the 11 standard lateral cephalometric landmarks recorded on each cephalogram. The data were classified into five groups according to age at time of cephalogram, and sets of paired non-syndromic cleft and VDW measurements were tested for differences using a Wilcoxon signed rank sum test in two ways, first including all cleft types and then including only those patients with complete bilateral cleft lip and palate. A longitudinal growth analysis considering the movement of the skeletal A and B points was performed on the patients with complete bilateral cleft lip and palate. For the osseous measurements, anteroposterior maxillary length as described by the anterior nasal spine (ANS)-posterior maxillary point distance was statistically significantly shorter in the VDW patients of age 13 years and older, by 5.3 mm. Maxillary height, as described by the nasion-ANS distance was shorter in the VDW patients, closely approaching statistical significance in the age range 7 through 11 years. The lip soft tissue measurements showed significantly greater protrusion over several age ranges in the VDW patients. The longitudinal growth analysis showed a significantly more inferior vertical position of the B point in the controls. This study demonstrates a few statistically significant differences in maxillary growth and lip conformation between VDW and matching controls. Small sample sizes for each age group hamper the ability to fully interpret or generalize the pattern of these differences.

Uvular Transposition: A New Method of Cleft Palate Repair

This prospective study was done to determine whether a new cleft palate repair utilizing uvular transposition improved speech outcome as measured objectively by a speech pathologist. In the uvular transposition procedure, the palate was lengthened with tissue from the uvula by a double-opposing Z-plasty; an intravelar veloplasty was performed, and two-thirds of the mass of the uvula was transposed to the nasal surface of the soft palate. This procedure facilitates velopharyngeal closure by significantly lengthening the palate, anatomically reconstructing the muscles of the palate, and decreasing the palatal excursion necessary to achieve closure. Sixty-two children with a cleft palate were treated with this procedure performed by the senior surgeon between the years of 1988 and 1995. These children were then enrolled in cleft lip and palate clinic at age 2 to 3 years and blindly evaluated yearly by a single speech pathologist who specialized in pediatric speech pathology. Postoperative clinical follow-up ranged from 36 to 112 months (mean, 56.8 months). Perceptual nasal emission was found to be normal in 59 of the 62 patients (95 percent). Nasometry was performed in all 62 of these patients, and the mean score was 15.7 percent, well within the accepted normal range of 25 or less at our institution. Only two of these children (3 percent) required a pharyngeal flap for velopharyngeal insufficiency. These findings suggest that the uvula transposition cleft palate repair may result in good normalization of speech with negligible rates of velopharyngeal insufficiency.

Uvular Transposition: A New Method of Cleft Palate Repair

This prospective study was done to determine whether a new cleft palate repair utilizing uvular transposition improved speech outcome as measured objectively by a speech pathologist. In the uvular transposition procedure, the palate was lengthened with tissue from the uvula by a double-opposing Z-plasty; an intravelar veloplasty was performed, and two-thirds of the mass of the uvula was transposed to the nasal surface of the soft palate. This procedure facilitates velopharyngeal closure by significantly lengthening the palate, anatomically reconstructing the muscles of the palate, and decreasing the palatal excursion necessary to achieve closure. Sixty-two children with a cleft palate were treated with this procedure performed by the senior surgeon between the years of 1988 and 1995. These children were then enrolled in cleft lip and palate clinic at age 2 to 3 years and blindly evaluated yearly by a single speech pathologist who specialized in pediatric speech pathology. Postoperative clinical follow-up ranged from 36 to 112 months (mean, 56.8 months). Perceptual nasal emission was found to be normal in 59 of the 62 patients (95 percent). Nasometry was performed in all 62 of these patients, and the mean score was 15.7 percent, well within the accepted normal range of 25 or less at our institution. Only two of these children (3 percent) required a pharyngeal flap for velopharyngeal insufficiency. These findings suggest that the uvula transposition cleft palate repair may result in good normalization of speech with negligible rates of velopharyngeal insufficiency. (Plast. Reconstr. Surg. 104: 897, 1999.)

Effect of method of cleft palate repair on the quality of speech at the age of 6 years: Haapanen, ML. Scand J Plast Reconst Hand Surg 29:245, 1995

Effect of method of cleft palate repair on the quality of speech at the age of 6 years: Haapanen, ML. Scand J Plast Reconst Hand Surg 29:245, 1995

Effect of Method of Cleft Palate Repair on the Quality of Speech at the Age of 6 Years

Two methods of primary palatal repair were compared for the effect that they had on the speech of 6 year old children with cleft (lip and) palate. A Veau-Wardill-Kilner V to Y pushback operation was done for 43 children (group V) and the Cronin modification for 60 children (group C) between the ages of 12 and 18 months. The groups were compared with respect to the quality of speech assessed clinically by perception, by instrumental measures of nasalance, and by the number of velopharyngeal flaps required. The quality of speech was assessed in terms of perceived signs of velopharyngeal insufficiency: hypernasality, audible nasal air emissions, weakness of plosives and compensatory articulations. Hypernasality was significantly more common in group V (16/33, 48%) than in group C (11/49, 22%) (p = 0.01). The number of velopharyngeal flaps and the nasalance scores derived from most of the individual test sentences were similar in the two groups. The mean nasalance score for the whole set of test sentences was significantly higher in group V.

Primary closure of cleft palate: a functional approach

The role of the different zones of palatal mucosa in maxillary growth are considered and their relevance in surgery of cleft palate discussed. A method of cleft palate repair is described, based on a functional repair of the soft palate, followed by later closure of the hard palate taking into account the anatomy and physiology of the palatal mucosa.

Effect of Timing and Method of Cleft Palate Repair on Dental Arches at the Age of Three Years

The purpose of this study was to compare the influence of two different ages at the time of palatal closure and two surgical methods on the size of the dental arches at the age of 3 years in children, with CP, UCLP, and BCLP. In 88 children the one-stage palatal closure had been performed at the age of 1.8 years and in 92 children at the age of 1.1 years. In both groups palatal surgery had been performed with a V to Y push back procedure (Veau-Wardill-Killner) or with the Cronin modification. Dimensions of the maxillary arch in both groups at age 3 were smaller than in noncleft children, but the timing of palatal closure did not affect arch dimensions in children with CP, UCLP, or BCLP. Arch dimensions at 3 years of age were not related to the method used in palatal closure.

Effect of Timing and Method of Cleft Palate Repair on Dental Arches at the Age of Three Years

Effect of Timing and Method of Cleft Palate Repair on Dental Arches at the Age of Three Years

Preliminary report of a new method of cleft palate repair

Preliminary report of a new method of cleft palate repair

Preliminary report of a new method of cleft palate repair : Reid CD, Watson JD. Br J Plast Surg 41:234, 1988

Preliminary report of a new method of cleft palate repair : Reid CD, Watson JD. Br J Plast Surg 41:234, 1988

Occurrence of oronasal fistulas in operated cleft palate patients

Oronasal fistulas, a troublesome complication, often occur after cleft palate repair. Seventy-three patients in a series of 346 cases of cleft palate (21%) were found to have fistulas, most located at the junction of hard and soft palate (42%). Langenbeck's method of cleft palate repair resulted in more fistulas than Wardill's method. Fistulas occurred more frequently in bilateral clefts than in the unilateral type. Nasality was found to be the most common symptom in patients with oronasal fistulas. No treatment was needed for 17 patients, 10 were given obturators, and surgical repair was performed in 46. Treatment was totally successful in 56% of the patients and partially so in 34%.

Preliminary report of a new method of cleft palate repair

A new method of cleft palate repair is described and the preliminary results of its use in five consecutive cases reported.