Cleft Palate Repair Research Articles

Travel Distance and Spanish-Speaking are Associated with Delays in the Treatment of Cleft Palate.

Delayed repair of cleft palate is associated with worse speech outcomes. Social determinants of health may influence the timing of surgery; however, there are no population health investigations to evaluate factors such as travel distance, language barriers, and payer. This study sought to identify factors that may interfere with timely cleft palate repair. Retrospective cohort. National/multi-center. All cleft palate repairs within California were extracted from 2000-2021. The primary outcome was age at surgical repair, which was modeled with linear regression. Covariates included race, primary language, distance from patient home to hospital, socioeconomic status, primary payer, and managed care enrollment status. 11 260 patients underwent surgical repair of a cleft palate. Black race was associated with delayed repair (22 additional days, P = .004, 95% CI 67.00-37.7) along with Asian/Pacific-Islander race (11 additional days, P = .006, 95% CI 3.26-18.9) compared to white race. Spanish-speaking patients had significantly later cleft palate repairs by 19 days, (P < .001, 95% CI 10.8-27.7) compared with English-speaking. Further distances from the hospital were significantly associated with later cleft surgeries with out-of-state patients undergoing surgery 52 days later (P < .001, 95% CI 11.3-24.3). Managed care plans and Medi-Cal were significantly associated with earlier surgical repair compared with private insurance. Black, Asian Pacific Islander, and Spanish-speaking patients and greater distance traveled to hospital were associated with delayed cleft palate repairs. These results underscore the importance of addressing structural and social barriers to care to improve outcomes and reduce health disparities for patients with cleft palate.

Medially Positioned Single Mucoperiosteal Flap With and Without Allograft Membrane for Repair of Congenital Cleft Palate in 4 Dogs.

Congenital cleft of the secondary palate occurs when there is failure of one or both maxillary processes to fuse with the nasal septum during embryonic development. Palatal cleft severity can range from a simple focal fissure of the caudal soft palate to full-thickness defects of varied widths involving the entire soft and hard palate. A novel staged medially positioned single mucoperiosteal flap technique in 4 canine patients is reported. This flap technique is based on the major palatine and infraorbital arteries with strategic extractions of maxillary teeth and placement of allograft membrane in 3 of 4 cases for treatment of clefts wider than may be repaired effectively by traditional methods.

Application of 3D Printing in Cleft Lip and Palate Repair.

This manuscript reviews the transformative impact of 3-dimensional (3D) printing technologies in the treatment and management of cleft lip and palate (CLP), highlighting its application across presurgical planning, surgical training, implantable scaffolds, and postoperative care. By integrating patient-specific data through computer-aided design and manufacturing, 3D printing offers tailored solutions that improve surgical outcomes, reduce operation times, and enhance patient care. The review synthesizes current research findings, technical advancements, and clinical applications, illustrating the potential of 3D printing to revolutionize CLP treatment. Further, it discusses the future directions of combining 3D printing with other innovative technologies like artificial intelligence, 4D printing, and in situ bioprinting for more comprehensive care strategies. This paper underscores the necessity for multidisciplinary collaboration and further research to overcome existing challenges and fully utilize the capabilities of 3D printing in CLP repair.

Dehiscence and Fistula Formation Following Anterior Palatal Reconstruction With Vomer Flap.

Anterior palatal reconstruction using vomer flaps has been described during primary cleft lip repair. In this procedure, the mucoperiosteal tissue of the vomer is elevated to reconstruct the nasal mucosa overlying the cleft of the hard palate. Here the authors, evaluate the efficacy of a technique in which a superiorly based vomer flap is sutured to the lateral nasal mucosa. The authors assess vomer flap dehiscence rates and compare the likelihood of fistula development in this cohort to patients who underwent palatoplasty without vomer flap reconstruction. A retrospective chart review was conducted of all palatoplasties performed by the senior author at an academic institution during a 7-year period. Medical records were reviewed for demographic variables, operative characteristics, and postoperative complications up to 1 year following surgery. Logistic regression analysis was conducted to assess the effects of vomer flap reconstruction on fistula formation, adjusting for age and sex. Fifty-eight (N=58) patients met the inclusion criteria. Of these, 38 patients (control group) underwent cleft palate reconstruction without previous vomer flap placement. The remaining 20 patients underwent cleft lip repair with vomer flap reconstruction before palatoplasty (vomer flap group). When bilateral cases were counted independently, 25 total vomer flap reconstructions were performed. Seventeen of these 25 vomer flap reconstructions (68%) were completely dehisced by the time of cleft palate repair. In the vomer flap group, 3 of the 20 patients (15%) developed fistulas in the anterior hard palate following the subsequent palatoplasty procedure. In the control group, only 1 of the 38 patients (2.6%) developed a fistula in the anterior hard palate. There was no significant association between cohorts and the development of anterior hard palate fistulas [odds ratio=10.88, 95% confidence interval (0.99-297.77) P =0.07], although analysis was limited by low statistical power due to the small sample size. In our patient population, anterior palatal reconstruction using a superiorly based vomer flap technique was associated with complete dehiscence in 68% of cases. Fistula formation in the anterior hard palate was also proportionately higher following initial vomer flap reconstruction (15% versus 2.6%). These results prompted the senior author to adjust his surgical technique to 1 in which the vomer flap overlaps the oral mucosa. While follow-up from these adjusted vomer flap reconstruction cases remains ongoing, early evidence suggests a reduced requirement for surgical revision following implementation of the modified technique.

Cleft Lip and Palate Repairs in Togo, “Sourire de l’Espoir” Humanitarian Missions’ Experience: A Retrospective Study of 201 Consecutive Cases

_Objective_: To describe “Sourire de l’Espoir” humanitarian missions on cleft lip and palate (CLP) repair and how it shaped the future of CLP repair in Togo. _Design_: Retrospective. _Patients_: Clinical files of patients operated on for CLP during humanitarian missions from October 2008 to May 2013 in Lome, the capital of Togo, were reviewed in a nine-month postoperative assessment from June to December 2020. Demographics, clinical, and therapeutic patterns were assessed. We also assessed the Zwisch method used for the training of local surgeons during the missions. Statistical analysis was performed with Epi Info (CDC version 7.1.3.3-2013). _Results_: CLP repair was performed in 201 patients during 10 missions. Patients’ mean age was 7.05 (SD 9.22) years (range: 3 months-50 years); the sex ratio (male/female) was 1.05. Distribution of cases was as follows: Cleft lip (CL) 109/201 (54.23%); cleft palate (CP) 53/201 (26.23%), and CLP 39/201 (19.40%). The Tennison-Borde-Bedouelle-Malek technique was used for the repair of CL in 119/148 patients (80.41%); the Onizuka technique (modified Millard technique) for the revision surgery of CL in 19 patients previously operated in other settings. The Kriens and Sommerlad palatoplasty technique was performed for primary and revision surgeries for all CP in 89/92 (96.73%) patients. The postoperative course was uneventful in 199/201 (99.00%) patients. One patient presented with an infection on the lip that healed with local wound care, and two patients with palatal fistula were treated by revision surgery. Two patients died in post-operative period. Three surgeons of the local team were trained as per the Zwisch method: in the first two missions, show and tell (60/201 cases), the third and fourth missions, smart help step (48/201 cases); from the seventh mission onwards, passive assistance (51/201 cases) by the local surgeons with no help. _Conclusion_: The “Sourire de l’Espoir” humanitarian missions provided primary and revision surgery to children and adults with CLP while three local surgeons were trained to build a local capacity.

Same-day Discharge for Cleft Palate Repair: A Single-Surgeon Retrospective Analysis.

To evaluate the safety of same-day discharge for patients undergoing primary cleft palate repair. Single-surgeon retrospective review. Tertiary care institution. 40 consecutive patients that underwent primary cleft palate repair by a single surgeon from September 2018 to June 2023. Same-day discharge versus overnight admission after primary palatoplasty. 30-day readmission, reoperation, wound and all-cause complication rate and 1-year fistula incidence. Of 40 total cases, 20 patients were discharged on the same calendar day and 20 patients were admitted for overnight stay following primary cleft palate repair. In the same-day discharge group, readmission incidence was 10%(n = 2), wound complication incidence was 5%(n = 1), and postoperative complication incidence was 15%(n = 3). In comparison, patients admitted overnight had a readmission incidence of 5%(n = 1, P = 1.00), wound complication incidence of 10%(n = 2, P = 1.00), and postoperative complications of 20%(n = 4, P = 1.00) No patients had 30-day reoperations or fistulas at 1 year. A higher proportion of admitted patients held a preoperative diagnosis of unilateral cleft palate and alveolus (Veau 3) as compared to patients discharged on the same day (P = .019). During the postoperative hospital course, admitted patients received significantly more oxycodone at median of 2 doses (IQR 1.00-3.75) and acetaminophen at a median of 4 doses (IQR 3.00-5.00) than patients with same-day discharge with a median of 1 dose (IQR 0.00 -1.00, P < .001). In a low-risk patient population, same-day discharge following primary cleft palate repair may be safely undertaken and result in similar short-term outcomes and 1-year fistula incidence as patients admitted for overnight stay.

Systematic review and meta-analysis of speech outcome among different surgical techniques post cleft palate repair: Furlow against other palatoplasty techniques

Systematic review and meta-analysis of speech outcome among different surgical techniques post cleft palate repair: Furlow against other palatoplasty techniques

Incidence of Velopharyngeal Insufficiency after Primary Cleft Palate Repair: A 27-Year Assessment of One Surgeon's Experience.

Background Velopharyngeal insufficiency (VPI) is a major complication of cleft palate repair. The purpose of this study was to evaluate the incidence and predictive factors of VPI after cleft palate repair based on 27 years of one surgeon's experience. Methods Medical records were retrospectively reviewed for 652 patients who underwent cleft palate repair between 1995 and 2021. After exclusion of those with other syndromes or developmental disorders, the study included 374 patients with sufficient follow-up until the age of 4 years, when language evaluation was possible. VPI status was categorized through subjective and objective tests into normal, VPI, and borderline. We analyzed potential differences in VPI incidence by multiple factors. Factors with significance were analyzed to confirm the relationships between subvariables. Results Of the 374 patients, 311 (83.2%) exhibited normal pronunciation, 51 (13.6%) had VPI, and 12 (3.2%) were borderline. Primary cleft palate repair performed after 18 months was associated with a higher incidence of VPI than repair conducted before 18 months ( p = 0.005). The incidence of VPI was higher in cases of submucous cleft palate than in the other types based on the Veau classification ( p = 0.011). However, in the multivariable analysis, only the submucous type showed statistically significant results ( p = 0.026). Conclusion A total of 374 people underwent primary cleft palate repair, and 13.6% of those with VPI required secondary therapy. The incidence of VPI was relatively high among patients with primary cleft palate repair after 18 months and patients with submucous cleft palate.

D24. Financial Toxicity Associated With Cleft Palate Repair: A Survey of Family Financial Well-being

D24. Financial Toxicity Associated With Cleft Palate Repair: A Survey of Family Financial Well-being

4. Reducing Fistula: A Retrospective Cohort Study of 1000 Cleft Palate Repairs by a Single Surgeon

4. Reducing Fistula: A Retrospective Cohort Study of 1000 Cleft Palate Repairs by a Single Surgeon

Cleft Lip and Palate Repairs in Togo, “Sourire de l’Espoir” Humanitarian Missions’ Experience: A Retrospective Study of 201 Consecutive Cases

_Objective_: To describe “Sourire de l’Espoir” humanitarian missions on cleft lip and palate (CLP) repair and how it shaped the future of CLP repair in Togo. _Design_: Retrospective. _Patients_: Clinical files of patients operated on for CLP during humanitarian missions from October 2008 to May 2013 in Lome, the capital of Togo, were reviewed in a nine-month postoperative assessment from June to December 2020. Demographics, clinical, and therapeutic patterns were assessed. We also assessed the Zwisch method used for the training of local surgeons during the missions. Statistical analysis was performed with Epi Info (CDC version 7.1.3.3-2013). _Results_: CLP repair was performed in 201 patients during 10 missions. Patients’ mean age was 7.05 (SD 9.22) years (range: 3 months-50 years); the sex ratio was 1.05. Distribution of cases was as follows: Cleft lip (CL) 109/201 (54.23%); cleft palate (CP) 53/201 (26.23%), and CLP 39/201 (19.40%). The Tennison-Borde-Bedouelle-Malek technique was used for the repair of CL in 119/148 patients (80.41%); the Onizuka technique (modified Millard technique) for the revision surgery of CL in 19 patients previously operated in other settings. The Kriens and Sommerlad palatoplasty technique was performed for primary and revision surgeries for all CP in 89/92 (96.73%) patients. The postoperative course was uneventful in 199/201 (99.00%) patients. One patient presented with an infection on the lip that healed with local wound care, and two patients with palatal fistula were treated by revision surgery. Two patients died in post-operative period. Three surgeons of the local team were trained as per the Zwisch method: in the first two missions, show and tell (60/201 cases), the third and fourth missions, smart help step (48/201 cases); from the seventh mission onwards, passive assistance (51/201 cases) by the local surgeons with no help. _Conclusion_: The “Sourire de l’Espoir” humanitarian missions provided primary and revision surgery to children and adults with CLP while three local surgeons were trained to build a local capacity.

Perspectives on the state of cleft lip and cleft palate patient care in Africa.

Patients with cleft lip -palate (CLP) experience morbidity and social stigma, particularly in low-income and middle-income countries (LMICs) such as those of sub-Saharan Africa (SSA). Delays in treatment secondary either to lack of awareness, skills, equipment and consumables; poor health infrastructure, limited resources or a combination of them, has led to SSA having the highest rates of death and second highest rates of disability-adjusted life years in patients with CLP globally. Here we review current perspectives on the state of comprehensive cleft lip and palate repair in Africa. To bridge gaps in government health services, nongovernmental organizations (NGOs) have emerged to provide care through short-term surgical interventions (STSIs). These groups can effect change through direct provision of care, whereas others strengthen internal system. However, sustainability is lacking as there continue to be barriers to achieving comprehensive and longitudinal cleft care in SSA, including a lack of awareness of CLP as a treatable condition, prohibitive costs, poor follow-up, and insufficient surgical infrastructure. With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable CLP services is possible in countries with limited resources. The replacement of CLP 'missions' with locally initiated, internationally supported capacity building initiatives, integrated into local healthcare systems will prove sustainable in the long-term.

Discussion: The Effects of Gingivoperiosteoplasty and Cleft Palate Repair on Facial Growth.

Discussion: The Effects of Gingivoperiosteoplasty and Cleft Palate Repair on Facial Growth.

Effectiveness of secondary furlow palatoplasty with buccal myomucosal flap in correction of velopharyngeal insufficiency in patients with cleft palate

ObjectivesThe main purpose of this study was evaluation of the effectiveness of secondary furlow palatoplasty with buccal myomucosal flap (FPBF) for the treatment of velopharyngeal insufficiency (VPI) in patients with a cleft palate who were treated with two flap palatoplasty (TFP) in their primary palate repair.Material and methodsTwenty-three medically free children aged 4–8 years with non-syndromic and previously repaired cleft palate via TFP participated in the study. All patients received secondary surgery following the technique of FPBF. Preoperative speech evaluation was done before the secondary repair and 3 months after the surgery using a hypernasal speech scale, speech intelligibility scale, and nasopharyngoscopy.ResultsA statistically significant improvement was observed regarding the degree of hypernasality and speech intelligibility while comparing the preoperative scores after the primary surgery to the postoperative scores after the secondary surgery.In addition, a statistically significant improvement was found in the nasopharyngoscopic assessment.ConclusionsThe incorporation of a buccal myomucosal flap with Furlow palatoplasty was successful in improving hypernasality, speech intelligibility, and nasopharyngoscopic scores in patients with cleft palate.Trial registrationclinicaltrials.gov (NCT05626933).Clinical relevanceThis technique might be the surgical technique of choice while treating patients who are suffering from VPI after cleft palate repair.

Cleft Lip and Palate Repairs in Togo, “Sourire de l’Espoir” Humanitarian Missions’ Experience: A Retrospective Study of 201 Consecutive Cases

Objective: To describe “Sourire de l’Espoir” humanitarian missions on cleft lip and palate (CLP) repair and how it shaped the future of CLP repair in Togo. _Design_: Retrospective. _Patients_: Clinical files of patients operated on for CLP during humanitarian missions from October 2008 to May 2013 in Lome, the capital of Togo, were reviewed in a nine-month postoperative assessment from June to December 2020. Demographics, clinical, and therapeutic patterns were assessed. We also assessed the Zwisch method used for the training of local surgeons during the missions. Statistical analysis was performed with Epi Info (CDC version 7.1.3.3-2013). _Results_: CLP repair was performed in 201 patients during 10 missions. Patients’ mean age was 7.05 (SD 9.22) years (range: 3 months-50 years); the sex ratio was 1.05. Distribution of cases was as follows: Cleft lip (CL) 109/201 (54.23%); cleft palate (CP) 53/201 (26.23%), and CLP 39/201 (19.40%). The Tennison-Borde-Bedouelle-Malek technique was used for the repair of CL in 119/148 patients (80.41%); the Onizuka technique (modified Millard technique) for the revision surgery of CL in 19 patients previously operated in other settings. The Kriens and Sommerlad palatoplasty technique was performed for primary and revision surgeries for all CP in 89/92 (96.73%) patients. The postoperative course was uneventful in 199/201 (99.00%) patients. One patient presented with an infection on the lip that healed with local wound care, and two patients with palatal fistula were treated by revision surgery. Two patients died in post-operative period. Three surgeons of the local team were trained as per the Zwisch method: in the first two missions, show and tell (60/201 cases), the third and fourth missions, smart help step (48/201 cases); from the seventh mission onwards, passive assistance (51/201 cases) by the local surgeons with no help. _Conclusion_: The “Sourire de l’Espoir” humanitarian missions provided primary and revision surgery to children and adults with CLP while 3 local surgeons were trained to build a local capacity.

Cleft lip and palate surgery simulator: Open source simulation model

ObjectiveCleft lip and palate is the most common craniofacial birth anomaly and requires surgery in the first year of life. However, craniofacial surgery training opportunities are limited. The aim of this study was to present and evaluate an open-source cleft lip and palate hybrid (casting and three-dimensional (3D) printing) simulation model which can be replicated at low cost to facilitate the teaching and training of cleft surgery anatomy and techniques. DesignThe soft tissue component of the cleft surgery training model was casted using a 3D printed 5-component mold and silicone. The bony structure was designed to simulate the facial anatomy and to hold the silicone soft tissue. SettingTwo groups, one group of trainees and one group of expert surgeons, at University Hospital Basel in Switzerland and Pontifical Catholic University of Chile in Santiago, Chile, tested the cleft lip and palate simulation model. Participants completed a Likert-based face and content validity questionnaire to assess the realism of the model and its usefulness in surgical training. ResultsMore than 70 % of the participants agreed that the model accurately simulated human tissues found in patients with unilateral cleft lip and palate. Over 60 % of the participants also agreed that the model realistically replicated surgical procedures. In addition, 80–90 % of the participants found the model to be a useful and appropriate tool for teaching the anatomy and surgical techniques involved in performing unilateral cleft lip and palate repair. ConclusionThis open-source protocol provides a cost-effective solution for surgeons to introduce the cleft morphology and surgical techniques to trainees on a regular basis. It addresses the current financial barrier that limits access to commercially available models during the early stages of surgeon training prior to specialization in the field.

Outcomes of primary repair of cleft palate using sommerled intravelar veloplasty associated with velocardiofacial syndrome

ObjectivesVelocardiofacial syndrome, a prevalent microdeletion syndrome occurring in 1 in 2000–4000 live births, is marked by speech and language disorders, notably velopharyngeal dysfunction. This study investigates speech outcomes, nasometric and videofluoroscopic results before and after primary repair of cleft palate using the Sommerlad intravelar veloplasty (SIVV) technique within the Isfahan cleft care team for patients with velocardiofacial syndrome. MethodsEmploying a quasi-experimental design, 19 participants with velocardiofacial syndrome, who underwent primary cleft palate repair by the Isfahan cleft care team, were included through convenience sampling. Perceptual and instrumental outcomes were assessed pre-and post-operatively. Statistical analysis encompassed paired t-tests and the non-parametric Wilcoxon signed-rank test (p < 0.05). ResultsThe study identified no statistically significant differences between pre-and post-surgical speech outcome parameters and nasalance scores. Nonetheless, a significant distinction emerged in the velopharyngeal closure ratio based on fluoroscopic evaluation (p = 0.038). ConclusionThe efficacy of the SIVV technique in treating velopharyngeal dysfunction in velocardiofacial syndrome patients is inconclusive, demanding further research. Post-surgical speech outcomes are influenced by surgical technique, hypotonia, apraxia of speech, and surgery timing. Notably, an elevated velopharyngeal valve closure ratio, though anatomically indicative, does not exclusively predict surgical success.

'Suspension Palatoplasty' - A method of surgical correction of VPI post Cleft Palate repair.

To design the technique of 'Suspension Palatoplasty' for Velopharyngeal Insufficiency (VPI) post Cleft Palate (CP) based on optimal spatial positioning of palate at the time of VPI correction, by using a non-obstructive, high, midline pharyngeal flap for predictable velopharyngeal closure and normal speech. To evaluate the results of CP patients with VPI operated using the technique of 'Suspension palatoplasty'. An ambi-spective longitudinal clinical study. Comprehensive cleft care clinic in a private trust hospital. Patients operated using the 'Suspension Palatoplasty' technique for VPI post CP repair between 2014 and 2018 with a minimum follow-up period of 5 years. 'Suspension Palatoplasty' - Double Opposing Z (DOZ) plasty with palatal myoplasty is used to revise soft palate and a narrow superiorly based pharyngeal flap is used to suspend it for a dynamic velopharyngeal closure. Speech outcome and surgical complications. 70 out of 119 studied were found to have normal speech (59%), and another 25 patients (21%) had acceptable speech. Thus 95 out of 119 patients (80%) had normal or near-normal speech and did not require any further speech therapy or surgeries. 12 patients had snoring without difficulty in breathing. One patient had symptoms suggestive of obstructive sleep apnea. Younger patients had a higher percentage of normal speech outcomes. Many of our adult patients also attained normal speech. 'Suspension Palatoplasty' aims to achieve normal speech with little effort. It has minimal side effects. The author has performed 403 cases to date.

The relationship between cleft palate repair technique and audiological outcomes: A retrospective cohort study.

Otitis media with effusion is common in children with cleft palates. This study aimed to investigate the link between palatal closure techniques and audiological outcomes. In this retrospective-prospective cohort study, we examined the relationship between palate repair techniques and hearing outcomes in children with cleft palates. From 2017 to 2022, 190 ears of 95 cleft patients were studied at the Cleft Lip and Palate Department of Shiraz University of Medical Sciences. Variables assessed included the surgical technique, cleft severity, auditory brainstem response (ABR) threshold, and tympanometry configuration. The mean ABR improved from a prepalatoplasty value of 39.51(11.62) decibels (dB) to a postpalatoplasty mean of 26.61(11.60) dB (Cohen's d: 1.12 [95% CI; 0.90-1.34]). Initially, 87.9% of the studied ears exhibited abnormal tympanometry, but this significantly decreased to 47% postsurgery (risk ratio: 4.43 [95% CI; 1.20-16.43]). When compared with Sommerlad intravelar veloplasty, the Nadjmi modified Furlow palatoplasty was associated with a notably lower mean ABR (β: -6.58 [95% CI: -10.43 to -2.73], p-value = .001) and a reduced frequency of abnormal tympanometry (odds ratio [OR]: -1.10; 95% CI: -1.85 to -0.36, p-value = .004). Factors like prepalatoplasty ABR, cleft palate severity, gender, and syndromic did not confound these findings. Although the Nadjmi modified Furlow palatoplasty showed better results, our findings indicate a significant improvement in ABR and tympanometry outcomes for both techniques. Future randomized controlled trials are suggested to confirm the influence of palatal closure techniques on audiological outcomes. 3b.

A Single Institution 19 Year Comparison of Furlow and Straight Line Palatoplasty Techniques in Bilateral Cleft Lip and Palate.

This study aims to compare patients' speech correcting surgery and fistula rates between the Furlow and Straight Line (SLR) palatoplasty techniques when combined with greater palatine flaps for complete bilateral cleft lip and palate (BCLP) repair. This was a single-center IRB approved retrospective cohort study. This study took place at an urban tertiary academic center. All patients with BCLP anomalies that underwent repair between January 2003 and August 2022 were included. Patients with index operations at an outside institution or incomplete medical charting were excluded. A total of 1552 patients underwent palatoplasty during the study period. Of these, 192 (12.4%) met inclusion criteria with a diagnosis of BCLP. Primary outcomes of this study included rate of fistula and incidence of speech correcting surgery. Secondary outcomes included rate of surgical fistula repair. One hundred patients underwent SLR (52.1%) and 92 Furlow repair (47.9%). There was no significant difference in fistula rates between the SLR and Furlow repair cohorts (20.7% vs. 15.0%; p = 0.403). However, SLR was associated with lower rates of speech correcting surgery when compared to the Furlow repair (12.5% vs. 29.6%; p = 0.011). This study compares the effect of Furlow and SLR on speech outcomes and fistula rates in patients with BCLP. Our findings suggest that SLR resulted in an almost three times lower rate of velopharyngeal dysfunction requiring surgical intervention in patients with BCLP, while fistula rates remained similar.