Soft Palate Repair Research Articles

Cleft Lip and Palate Correction: The Utah Protocol.

Cleft repair remains a contentious issue in craniofacial surgery, especially regarding the optimal timing and techniques. This study aims to present our institutions' current protocol for cleft lip and palate repair, including alveolar bone grafting (ABG). A total of 17 patients (20 clefts) treated with the latest protocol from 2016 to 2023 were evaluated. Demographic and clinical data were obtained from electronic charts. The protocol includes lip repair at 3 months, soft palate repair at 1 year, and hard palate closure with concurrent ABG at 2 years. Mean graft height and thickness scores were 2.3 and 2.2, respectively. Three clefts showed scores marginally below the threshold for thickness, potentially requiring regrafting. Malocclusion was minimal with no significant crossbites or velopharyngeal insufficiency. Our modified protocol, emphasizing early hard palate closure with ABG, yields satisfactory outcomes in terms of graft height and thickness. Although long-term follow-up is warranted, our approach seems safe and efficient, potentially improving outcomes compared with traditional methods.

The Effects Of Early And Delayed Palatal Repair On Maxillary Growth And Speech Outcome In Unilateral Cleft Lip And Palate Patients: A Systematic Review

Some cleft clinics use a two-stage method to correct the cleft palate, which helps avoid reduced maximum growth after early hard palate surgery and impaired speech development after late soft palate repair.. This study sought to evaluate the effects of early vs late palatoplasty on speech and maximum growth results. The following databases were searched: Cochrane Library, Science Direct, Pubmed, and NCBI. The primary objective of this study was to determine whether unilateral, non-syndromic cleft lip, alveolus, and palate patients who underwent early or late hard palate surgery before or after 18 months of age had an impact on speech and maxillary development. Things like case studies, reviews, editorials, textbooks, and studies conducted on animals weren't included. The following systematic observations consist of eight studies. Most studies had methodological quality that ranged from fair to good. This review discusses the experience of cleft centers using a variety of one and two stage palatoplasty procedures and timing, and shows inconsistent results regarding maximal progression. The seemingly inconsistent results of the studies included in this observation of speech outcomes suggest that there is insufficient evidence to conclude whether one- or two-stage palatoplasty has a significant effect on maximal development for a variety of reasons. The review provides inconclusive evidence on the impact of hard palate repair timing on facial growth and speech outcomes in unilateral cleft lip and palate patients, highlighting the need for further controlled studies.

Modified Furlow palatoplasty using small double-opposing Z-plasty: Long-term outcome and comparison with two-flap palatoplasty.

The post-palatoplasty velopharyngeal function needs to be evaluated through long-term follow-up, but such reports are limited in the literature and there has been no consensus as to which surgical technique yields optimal velopharyngeal function with minimum complication rate. This study aimed to evaluate the long-term outcome of the modified Furlow palatoplasty using small double-opposing Z-plasty (small-DOZ). A retrospective review of consecutive patients who received palatoplasty performed by the senior author between January 2000 and March 2014 was conducted. Non-syndromic patients who underwent palatoplasty before the age of 18 months and followed-up until at least 9 years of age were included. Comparisons between the small-DOZ and two-flap methods for soft palate repair were made. A total of 196 small-DOZ and 167 two-flap palatoplasty patients were eligible in the study. Among the small-DOZ palatoplasty patients, 1 patient (0.5%) developed oronasal fistula, and 18 patients (9.2%) received velopharyngeal insufficiency (VPI) surgery (10 patients at preschool age and 8 at nine years of age). Compared with the small-DOZ palatoplasty, the oronasal fistula rate, VPI surgery rate, and the need for myringotomy tube insertion were significantly higher in the two-flap group (p =0.01, <0.01, <0.01, respectively). Patients who developed oronasal fistula had significantly higher likelihood of having velopharyngeal insufficiency (p < 0.01). The small-DOZ provided successful palatal repair with low rates of oronasal fistula and VPI in the long-term. Wound closure under minimal tension facilitated to avoid oronasal fistula. Reconstruction of the functional muscle sling enabled to achieve normal velopharyngeal function with favorable speech outcome and middle ear function.

Speech Outcomes Audit for Unilateral Cleft lip and Palate After 2-Stage Palate Repair: Preliminary Results.

Primary cleft lip and palate surgeries can interfere with speech status, facial appearance, maxillary growth, and psychosocial and academic development. Therefore, different surgical protocols and techniques have been proposed, and adequate velopharyngeal function and speech is the main goal for the treatment success. The present study aimed to report preliminary speech results of the 2-stage palate repair of children with unilateral cleft lip and palate. One hundred seventy nonsyndromic patients with unilateral cleft lip and palate were included in this report, 35% males and 65% females, submitted to the 2-stage palatoplasty protocol, composed by lip, nasal ala, and hard palate repair at 3 to 6 m (stage 1) and soft palate repair at 12 to 18 m (stage 2). The target age range for speech recording was 5 to 10 years, and the speech material included repetition of Brazilian Portuguese sentences. These samples were obtained over 5 years and assessed by 3 of 14 experienced speech pathologists. When discordant, the majority rate was adopted. Average velopharyngeal dysfunction (VPD) rates were 19,5%, varying according to the soft palate technique, with better results when the Sommerlad technique was performed (VPD=11%), followed by Braithwaite (VPD=15%) and then Von Langenbeck (VPD=25%). Passive errors were observed in 32% and active errors in 25%. Speech results reflect the outcomes of an interdisciplinary team's work, where facial growth and nasolabial appearance must also be considered. Further analysis and a wider casuistic are recommended. Hence outcomes audit needs to be a permanent process, providing solid and updated evidence for optimal cleft care.

Growth Outcomes Audit for Unilateral Cleft Lip and Palate (UCLP) After 2-stage Palate Repair.

To assess the impact of 1 and 2-stage palatoplasty protocol on the dental arch relationships in unilateral cleft lip and palate (UCLP) in a single center. Our study consisted of 349 individuals divided into 2 groups according to the palatoplasty protocol. Two-stage group comprised 169 subjects with UCLP (mean age: 6.9y, 110 male and 59 female) who underwent lip, nasal ala, and anterior palate repair with vomer flap from 3 to 6 months (first surgery stage). Soft palate repair occurred from 12 to 18 months (second surgery stage). The one-stage group comprised 180 subjects with UCLP (mean age: 7.2y, 108 male and 72 female) who underwent 1-stage palatoplasty. Dental models were evaluated by 3 experienced orthodontists applying Goslon Yardstick and the 5-year-old index (FYOI). The influence of the palatoplasty technique and surgeon factor on the interarch relationship was evaluated. The weighted Kappa was used to assess intraexaminer and interexaminer agreements for comparisons of dental arch relationships. Intergroup comparisons were conducted using the χ 2 test ( P <0.05). The intraexaminer reliability was very good (0.81 to 0.98) and interexaminer reliability varied from satisfactory to very good (0.56 to 0.83). The mean occlusal index of the 2-stage and 1-stage groups was 2.77 and 3.03, respectively. The variability of the mean index between surgeons varied from 2.38 to 3.2 in the 2-stage group and 2.91 to 3.2 in the 1-stage group. There were significant differences in the frequency of Goslon 5 index ( P =0.002) between groups, with the 2-stage group presenting less cases (1.18%) than the group 1-stage (11.11%). The interarch relationship was similar for both palate repair protocols. Two-stage palatoplasty showed a decreased prevalence of Goslon index 5.

Can the exoscope be a game-changer for cleft palate surgery?

Cleft palate surgery represents a challenge for cleft surgeons, due to functional implications of an adequate reconstruction of the palate in a narrow operative field [1] Levites H.A. Sergesketter A.R. Sharif-Askary B. Hollenbeck S.T. Allori A.C. Marcus J.R. Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation. Plast Reconstr Surg. 2020 Nov; 146: 1129-1132https://doi.org/10.1097/PRS.0000000000007291 Crossref Scopus (2) Google Scholar . Surgical loupes remain the mostly used magnification system for soft palate repair all over the world, with some drawbacks: restricted magnification capacity, offering a poor ergonomic posture, and limited surgical staff involvement. Furthermore, it is estimated that about 83% of cleft surgeons suffer from work-related musculoskeletal disorders and palate surgery can be considered one of the most uncomfortable procedures [1] Levites H.A. Sergesketter A.R. Sharif-Askary B. Hollenbeck S.T. Allori A.C. Marcus J.R. Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation. Plast Reconstr Surg. 2020 Nov; 146: 1129-1132https://doi.org/10.1097/PRS.0000000000007291 Crossref Scopus (2) Google Scholar . The introduction of the microscope [2] Sommerlad B.C. The use of the operating microscope for cleft palate repair and pharyngoplasty. Plast Reconstr Surg. 2003 Nov; 112: 1540-1541https://doi.org/10.1097/01.PRS.0000085598.26409 Crossref PubMed Scopus (0) Google Scholar for the video-assistance of cleft palate surgery offered stereoscopic vision with higher magnification capabilities, a better ergonomic position and, by connecting a monitor, a better involvement of the surgical staff. However, its use in pediatric transoral surgery presents some difficulties in terms of adaption and challenging setting: for these reasons, the microscope is widely used only for dissection of the muscular plane, limiting its advantages and increasing the surgical times with its setting and dismissal.

Chirurgische behandeling lip- en verhemeltespleet

Surgical treatment of cleft lip and palate Children with cleft lip and/or palate often undergo multiple surgical procedures to repair the lip and/or palate. The lip closure is usually done between the ages of 3 and 6 months, which may or may not be preceded by presurgical orthopedic treatment. The techniques used for cleft lip repair vary between different teams and surgeons. In addition to a correct alignment of the lip parts, the restoration of the continuity of the orbicularis oris muscle and the correct positioning of the base of the nostril are important. The timing and sequence of the hard and soft palate repair vary and are a trade-off between the beneficial effect of early palate repair on the velopharyngeal function and speech development, and the possible negative effect of palate repair on maxillary growth. The hard and soft palate can be closed simultaneously or in 2 operating times. Again, several techniques are available, always with the aim of achieving a complete closure of the mucosa without oronasal fistulas and with a functional velopharyngeal sphincter. For the latter, repositioning the palatine levators and restoring their continuity are crucial.

Hybrid Palatoplasty: A Simplified DOZ (Double Opposing Z Plasty) with Palatal Myoplasty for Primary Palate Repair.

Introduction Surgical techniques for soft palate repair aiming for zero velopharyngeal insufficiency (VPI) are still not achieved. Straight line closure of the soft palate by various techniques of intravelar veloplasty (IVVP) leads to higher incidence of VPI due to scar contracture. Furlow's Z plasty has long, narrow, thin mucosal flaps and mucomuscular flaps with malaligned muscle closure. We present a technique of "hybrid palatoplasty" which borrows from and adds to the existing methods, is robust, is easy to replicate, and results in normal speech consistently. Aim (1) To design a technique of "hybrid palatoplasty"-combining double opposing Z (DOZ) plasty and IVVP, which is applicable to all types of cleft palate. (2) To evaluate the results of cleft palate children operated using the technique of "hybrid palatoplasty" from 2014 to 2015 in terms of surgical complications (fistulae and dehiscence) and incidence of VPI. Methods Our procedure combines aspects of both DOZ and IVVP. It is simplified with design of smaller Z plasties. On one side, from the oral Z plasty muscle is dissected off and sutured to the nasal mucomuscular flap of the opposite side to complete the palatal sling. Oral Z plasty is purely mucosal and reverse of the nasal side. A total of 123 cases, operated below 5 years of age were followed up. Speech was assessed by direct evaluation and tele-evaluation. Results A total of 123 cases, below 5 years of age, were operated between 2014 and 2016 with at least 5 years of follow-up. Note that 120 had normal speech, and 3 had VPI of which 2 were subsequently corrected and went on to develop normal speech. Conclusion This novel "hybrid palatoplasty" is a simple technique with good speech outcome as it combines the principles of Z plasty and direct muscle repair with palatal sling formation.

Speech assessment following microsurgical soft palate repair

The aim of this study was to analyze speech intelligibility of children, who had undergone microsurgical soft palate repair according to Sommerlad.Cleft palate patients were treated by closure of the soft palate according to Sommerlad at about 6 months of age. At the age of 11, their speech was evaluated through automatic speech recognition. Word recognition rate (WR) was used as the outcome parameter of automatic speech recognition. To validate automatic speech results, an institute for speech therapy evaluated the speech samples for perceptual intelligibility. The results of this study group were compared to an age-matched control group.A total of 61 children were evaluated in this study, 29 in the study group and 32 in the control group. Study group patients had a lower word recognition rate (mean 43.03, SD 12.31) compared to the control group (mean 49.98, SD 12.54, p = 0.033). The magnitude of the difference was considered small (95% CI of the difference 0.6–13.3). The study group patients received significantly lower scores in the perceptual evaluation (mean 1.82, SD 0.58) compared to the control group mean (mean 1.51, SD 0.48, p = 0.028). Again, the magnitude of the difference was small (95% CI of the difference 0.03–0.57).Within the limitations of the study it seems that microsurgical soft palate repair according to Sommerlad at the age of 6 months might be a relevant alternative to other well established surgical techniques.

Occlusal Evaluation Using Modified Huddart and Bodenham Scoring System Following 2-Stage Palatoplasty With Hotz Plate: A Comparison Among 3 Different Surgical Protocols.

This study aimed to determine if the change in technique of soft palate closure or timing of hard palatal repair induced occlusal changes in patients with complete unilateral cleft lip and palate (CUCLP). Retrospective study. A medical and dental hospital in Japan. A total of 96 patients with CUCLP treated with 2-stage palatoplasty were included in the study and categorized into 3 groups (G1, G2, and G3) according to the protocol used. G1 underwent soft palate repair using Perko method at 1.5 years of age and hard palate repair using vomer flap procedure at 5.5 years of age. Furlow method was used for soft palate repair in G2 at 1.5 years of age and hard palate repair using vomer flap procedure at 5.5 years of age. The Furlow method was used to repair the soft palate in G3 at 1.5 years of age and vomer flap procedure was used to repair the hard palate at 4 years of age. Two evaluators assessed the dental arch relationship using the modified Huddart/Bodenham (mHB) index on 2 separate occasions. Intra- (intraclass correlation coefficient [ICC]: 0.962) and inter-examiner (ICC: 0.950) reliability showed very good agreement. The frequency of crossbite present in the major and minor segments gradually decreased with each change in protocol. Mean segmental scores showed no significant difference between 3 protocols (P > .05). Good inter-arch alignment occurred with all 3 surgical protocols (G1:82.6%, G2:89.8%, and G3:91.7%). There was no significant difference in the dental arch relationship outcomes between the 3 surgical protocols. The dentition status was comparable with all surgical protocols, even after the changes.

Fibrin with Laminin-Nidogen Reduces Fibrosis and Improves Soft Palate Regeneration Following Palatal Injury.

This study aimed to analyze the effects of fibrin constructs enhanced with laminin-nidogen, implanted in the wounded rat soft palate. Fibrin constructs with and without laminin-nidogen were implanted in 1 mm excisional wounds in the soft palate of 9-week-old rats and compared with the wounded soft palate without implantation. Collagen deposition and myofiber formation were analyzed at days 3, 7, 28 and 56 after wounding by histochemistry. In addition, immune staining was performed for a-smooth muscle actin (a-SMA), myosin heavy chain (MyHC) and paired homeobox protein 7 (Pax7). At day 56, collagen areas were smaller in both implant groups (31.25 ± 7.73% fibrin only and 21.11 ± 6.06% fibrin with laminin-nidogen)) compared to the empty wounds (38.25 ± 8.89%, p < 0.05). Moreover, the collagen area in the fibrin with laminin-nidogen group was smaller than in the fibrin only group (p ˂ 0.05). The areas of myofiber formation in the fibrin only group (31.77 ± 10.81%) and fibrin with laminin-nidogen group (43.13 ± 10.39%) were larger than in the empty wounds (28.10 ± 11.68%, p ˂ 0.05). Fibrin-based constructs with laminin-nidogen reduce fibrosis and improve muscle regeneration in the wounded soft palate. This is a promising strategy to enhance cleft soft palate repair and other severe muscle injuries.

Speech Outcome and Self-Reported Communicative Ability in Young Adults Born With Unilateral Cleft Lip and Palate: Comparing Long-Term Results After 2 Different Surgical Methods for Palatal Repair.

To compare speech outcome and self-reported speech and communicative ability (SOK) in young adults treated with one-stage (OS) or two-stage (TS) palatal repair. Furthermore, to compare with normative data on individuals without cleft lip and palate and to study the relationship between patients' and experts' judgments. A cross-sectional group comparison study with long-term follow-up. Participants: Patients born with unilateral cleft lip and palate treated at 2 cleft centers; 17 with OS at 14 months and 25 with TS, soft palate repair at 7 months and hard palate repair at 6.2 years. Pharyngeal flap surgery was performed in 53% (OS) and 24% (TS) of patients. Speech characteristics were blindly assessed by speech and language pathologist from audio recordings, SOK at 19 years of age. No group differences were found. Although the occurrence of nasality symptoms was low in both groups, only 60% (OS)/65% (TS) were assessed with competent velopharyngeal function (VPC). Articulation proficiency (percentage of consonants correct [PCC]) was 91%/97%, the /s/-sound specifically 87%/91%. Good intelligibility was found in 91%/87%. Patient opinion was in agreement with norms and significantly associated with intelligibility (rs = 0.436, P < .01), PCC (rs = -0.534, P < .01), and correct /s/ (rs = -0.354, P < .05). No differences in speech outcome were related to operation method. The low prevalence of VPC was not clearly reflected in nasality symptoms. Patient opinion was related to articulation and intelligibility. A higher burden of care in terms of pharyngeal flap surgery was seen after the OS technique.

Comparison of speech outcomes using type 2b intravelar veloplasty or furlow double-opposing Z plasty for soft palate repair of patients with unilateral cleft lip and palate

BackgroundThe aim of this study is to compare speech outcomes, fistula rates, and rates of secondary speech surgeries after palatoplasty using Furlow palatoplasty or type 2b intravelar veloplasty for soft palate repair. Patients and methodsPatients with unilateral cleft lip and palate who had either Furlow palatoplasty or intravelar veloplasty for soft palate repair were retrospectively evaluated for demographic and perioperative variables and speech outcomes. Fistula rate, secondary surgical intervention for improved speech results, and findings of speech assessment were further reviewed for the patients who met the inclusion criteria. ResultsA total of 76 patients, 36 in the Furlow palatoplasty group and 40 in the intravelar veloplasty group, were included in the study. In the speech assessment, nasalance values were statistically similar between the two groups. Also, there was no statistically significant difference between the groups in velopharyngeal motility (p = 0.103). The total rates of secondary surgeries and fistula were statistically similar between the groups (p = 0.347 and 0.105, respectively). ConclusionThe similar outcomes of speech and surgical evaluation between the two groups make the surgeon's preference determinant in the selection of the surgical technique for soft palate repair.

Longitudinal study of the development of obstruent correctness from ages 3 to 5 years in 108 Danish children with unilateral cleft lip and palate: a sub-study within a multicentre randomized controlled trial.

Speech-sound development in preschoolers with unilateral cleft lip and palate (UCLP) as a group is delayed/disordered, and obstruents comprise the most vulnerable sound class. To evaluate the development of obstruent correctness (PCC-obs) and error types (cleft speech characteristics (CSCs) and developmental speech characteristics (DSCs)) from ages 3-5 and to investigate possible predictors (error types, velopharyngeal dysfunction (VPD) and gender) of PCC-obs at age 5 in two groups of children with UCLP. Subgroup analysis was conducted within a multicentre randomized controlled trial (RCT) of primary surgery (Scandcleft Project). A total of 125 Danish children with UCLP received lip and soft palate repair around 4 months of age and early hard palate closure at 12 months (EHPC group) or late hard palate closure at 36 months (LHPC group). Audio and video recordings of a naming test were available for 108 children at ages 3 and 5, and recordings were transcribed phonetically by blinded raters. PCC-obs scores increased significantly from ages 3-5 in both groups, but with small effect sizes in the EHPC group that had higher scores at age 3 than the LHPC group. DSCs decreased in both groups whereas CSCs only decreased in the LHPC group that had more CSCs at age 3 than the EHPC group. The frequency of CSCs at age 3 was a significant predictor of PCC-obs scores at age 5 in both groups. DSCs significantly improved the logistic regression model in the EHPC group, whereas VPD and gender did not significantly improve the model in either group. Although PCC-obs developed significantly from ages 3 to 5, children with UCLP as a group did not catch up to typically developing Danish children at age 5. Furthermore, the LHPC group at age 5 did not reach the 3-year level of the EHPC group, which means that delaying hard palate closure until age 3 is detrimental to obstruent development. Both CSCs and DSCs at age 3 were important predictors of PCC-obs at age 5 and should be considered when determining need for intervention.

Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate.

To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). Tertiary health care. One surgical center. One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate "cleft size at tuberosity level" was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = -.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.

“Flip-over flap” in two-stage cleft palate repair

PurposeThis study served to evaluate a two-stage concept in cleft palate repair, including key use of a triangular hinge (“flip-over”) flap, in order to prevent palatal fistulae. It uses data from a prospective registry established in 1991. Materials and methodsThe concept entails Furlow soft palate repair (at 1 year of age) and hard palate closure (at 4 years) by a three-pronged approach [paring of the edges with or without postero-lateral relaxing incisions, peninsula (Veau) flap(s)], plus a triangular hinge flap. The latter is elevated from the oral layer of the already-repaired soft palate, stays based anteriorly, and is flipped over to close the posterior nasal layer defect. The case series is compared with data from the literature. ResultsThe palatal fistula rate for Veau II to IV types (two-stage surgeries) was 4.3%. The overall fistula rate in the cleft population (Veau I–IV) was 2.9%. Meta-analyses describe 4.9 and 8.6% on average. There was no difference between sample A in which the flip-over flaps were used only when modified Veau flaps were indicated (until 2006) and sample B in which it was used regardless of the technique of hard palate closure applied (2006–2018). The fistula rate decreased to zero after 2010, which may reflect also an influence of other factors such as the interpositioning of a collagen membrane and also of improved surgical judgment. ConclusionsUsing a flip-over flap in two-stage cleft palate repair may contribute to prevent fistula formation at the hard/soft palate junction. Level of evidenceIII.

Two Methods of Cleft Palate Repair in Patients With Complete Unilateral Cleft Lip and Palate

The objective of this study was to compare the surgical outcome between 2 patient groups with complete unilateral cleft lip and palate who underwent different types of palatoplasty. This is a cohort study between 2 groups of patients with complete unilateral cleft lip and palate who were operated using different surgical techniques from 2008 to 2011. About 28 patients were operated using a primary lip nose repair with vomer flap for hard palate single-layer closure and delayed soft palate repair (modified Oslo protocol) and 32 patients were operated using our protocol in Lima. Data collection was accomplished by evaluation of symptomatic oronasal fistulas, presence of velopharyngeal insufficiency and evaluation of dental arch relationships (scored using the 5-year-olds' index). Our comparative study observed statistically significant differences between the 2 groups regarding the presence of oronasal fistulas and velopharyngeal insufficiency in favor of our palatoplasty technique. A statistically significant difference was not found in functional vestibular oronasal fistula development between the studied techniques for unilateral cleft palate repair. This comparative study did not observe significant differences in dental arch relationships between the studied techniques. In this study, better surgical outcome than modified Oslo protocol regarding oronasal fistulas and velopharyngeal insufficiency on patients with complete unilateral cleft lip and palate was observed. The results arising from this study do not provide evidence that one technique is enough to obtain better functional closure of the alveolar cleft and dental arch relationship at 5 years.

A Review of Randomized Controlled Trials in Cleft and Craniofacial Surgery

This study presents a systematic review of randomized controlled trials (RCTs) in cleft and craniofacial surgery. All studies reporting on RCTs in cleft and craniofacial surgery were identified on PubMed using the search terms "cleft," "velopharyngeal insufficiency," "velopharyngeal dysfunction," "nasoalveolar molding," "gingivoperiosteoplasty," "Pierre Robin sequence," "craniofacial," "craniosynostosis," "craniofacial microsomia," "hemifacial microsomia," "hypertelorism," "Le Fort," "monobloc," "distraction osteogenesis," "Treacher Collins," and "Goldenhar." Studies were excluded if they were not randomized, did not focus primarily on topics related to cleft or craniofacial surgery, included repeat publications of data, or were unavailable in English. Studies were evaluated on demographic and bibliometric data, study size, specific area of focus, and findings reported. Four hundred forty-seven unique studies were identified. One hundred eighty-three papers met inclusion criteria (115 cleft lip and palate, 65 craniofacial, and 3 spanning both disciplines). Sixty-six (36%) were dedicated to topics related to surgical techniques. There were no studies comparing current cleft lip or soft palate repair techniques and no studies on cleft rhinoplasty. The most frequently reported surgical topic was cleft palate. There were several studies on orthognathic techniques which compared distraction osteogenesis to traditional advancement. Most craniofacial operations, such as cranial vault remodeling and frontofacial advancement/distraction, were not represented. Several standard operations in cleft and craniofacial surgery are not supported by Level I evidence from randomized controlled trials. Our community should consider methods by which more RCTs can be performed, or redefine the acceptable standards of evidence to guide our clinical decisions.

Cephalometric evaluation after two-stage palatoplasty combined with a Hotz plate: a comparative study between the modified Furlow and Widmaier–Perko methods

The effects on craniofacial growth of two different soft palate repair techniques in two-stage palatoplasty were investigated. This was a retrospective, cross-sectional cohort study of 68 children with non-syndromic, complete unilateral cleft lip and palate. Thirty-four patients were treated with the modified Furlow method (F-group) and the remaining 34 with the Widmaier–Perko method (P-group). Craniofacial growth was assessed by analyzing 12 angular and 12 linear measurements on lateral cephalograms. Composite facial diagrams from the two groups were compared with those of a control non-cleft group. Angular and linear measurements did not differ significantly between the two groups, implying that the craniofacial morphology was not affected by the difference in soft palate repair technique. However, small differences in anterior nasal spine and posterior nasal spine were found in cleft patients compared with controls. These findings suggest that the modified Furlow and Widmaier–Perko methods have a similar impact on craniofacial growth. Considering speech function, the modified Furlow method provides better craniofacial growth and speech function. However, the long-term effects of both methods on craniofacial growth after growth cessation remain to be determined.

Improvement of quality of speech in patients with velo-pharyngeal insufficiency corrected using a buccinator myomucosal flap.

Oro-facial clefts involving the palate is the commonest structural defect causing velopharyngeal insufficiency (VPI) and poor intelli gibility of speech. Proper repair of the soft palateis a surgical challenge. Posterior-based buccinator myomucosal flap (BMF) is used to lengthen the soft palate of patients who undergo primary palatoplasty at Teaching Hospital, Karapitiya (THK). BMF is a good choice for the repair of medium sized mucosal defects in the oral cavity since it has appropriate thickness, contains mucous membrane with mucous glands and has a rich blood supply. Objectives To assess improvement in quality of speech after soft palate repair using BMF in patients with previously corrected cleft pate. Thirty four patients (M:F-1:1) who had undergone palatal lengthening using BMF procedure for correction of VPI for speech improvement at Teaching Hospital, Karapitiya from 2010 to 2012, were assessed before and one year after surgery for quality of speech. All patients below 8 years showed significant reduction of hypernasality (p<0.05), whereas only 60% of patients above 8 years showed reduction after the surgery. All patients showed reduction in nasal air emission and in consonant production error at least by one consonant. The group below 8 years showed more improvement in speech quality after surgery. Palatal lengthening using BMF procedure is a good treatment option for correction of VPI.