A Comparative Study Evaluating Speech Outcomes in Classic versus Occult Submucous Cleft Palate Using a Primary Furlow Palatoplasty Technique

Abstract

Background: No consensus exists on the selection of procedures for the treatment of submucous cleft palate, with scarce reports on long-term outcomes from single-surgeon experience. This study assessed the outcomes of using extended indication criteria of Furlow palatoplasty as the first-line procedure for the management of submucous cleft palate–associated velopharyngeal insufficiency. Methods: Consecutive nonsyndromic patients with submucous cleft palate (n = 216) treated by a single surgeon between 1998 and 2018 were reviewed. Furlow palatoplasty was performed in all patients diagnosed with submucous cleft palate–associated velopharyngeal insufficiency, regardless of the age cutoff, number of Calnan triad features, or velopharyngeal gap size and pattern. Postoperative velopharyngeal function outcome (adequate, marginal, or inadequate) and the need for secondary surgery were investigated. Age at surgery, sex, submucous cleft palate type (classic and occult), and presence of complication were evaluated for potential associations with this outcome. Results: Forty-seven patients aged 8.3 ± 4.6 years with occult submucous cleft palate were significantly (p < 0.001) older than those with the classic type (n = 169; 5.6 ± 3.1 years). Most (p < 0.001) of the included patients [n = 181 (83.8 percent)] achieved adequate postoperative velopharyngeal function outcome. Three patients (1.4 percent) presented surgery-related complications, including bleeding and partial wound disruption. Secondary speech surgery was recommended in 24 patients (11.1 percent). In the bivariate and multivariate analyses, none of the tested variables was found to be associated (all p > 0.05) with the postoperative velopharyngeal function outcome. Conclusion: The extended indication criteria of Furlow palatoplasty provided adequate velopharyngeal insufficiency management with a low complication rate and satisfactory speech outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Speech Outcomes and Velopharyngeal Function in Children Undergoing Submucous Cleft Palate Repair

“…Its management remains challenging. 4,27 To describe the speech and velopharyngeal function of children with SMCP treated at our institution, we analyzed various variables.…”

“…This intraoral examination could be with or without nasopharyngoscopic evaluation as an additional diagnostic method to evaluate the structure (anatomy) of the velopharyngeal valve when there were vague clinical findings in symptomatic children older than 4 years (that is to say, collaborative patients). 27 In most cases, our team uses nasopharyngoscopic examination to confirm the suspicion of occult SMCP, after VPI diagnosis, even if there is no finding on intraoral inspection.…”

“…5 In the publication of Taiwan, 78.2% presented the classic variant, and 21.7% occult. 27 On the other hand, when analyzing the type of cleft in a population with syndromic association, the velocardiofacial syndrome (VCFS) is the most associated with occult SMCP and in second place to classic SMCP. 7 In a Chilean study, in 80 confirmed diagnoses of 22 deletion syndrome, it was confirmed that the proportion of occult SMCP (72.5%) is inverse, that is, greater than the classic SMCP (27.5%).…”

“…The SMCP can be considered a separate diagnostic category from the traditional cleft palate. Its management remains challenging 4,27 . To describe the speech and velopharyngeal function of children with SMCP treated at our institution, we analyzed various variables.…”

Submucous Cleft Palate (SMCP): Indications and Outcomes of Radical Muscle Dissection Palatoplasty in Children Under 4 Years of Age

“…11 Indeed, the choice of surgical treatment often varies depending on global location. Furlow's palatoplasty has been shown to provide satisfactory postoperative speech with a low complication rate 22,23 and safe use demonstrated in both overt and occult SMCP. 24 A systematic review comparing speech outcomes of SMCP with Furlow palatoplasty and pharyngeal flap combined with intravelar veloplasty confirmed the efficacy of both repair options though concluded that pharyngeal flaps should be considered in those with significant hypernasality.…”