An Outcome Study of a 2-Flap Pushback Palatoplasty Used in the Treatment of Wide Cleft Palates

Abstract

Cleft palate remains a common congenital deformity. The wide cleft palate in particular presents a unique challenge when attempting to restore a competent velopharyngeal mechanism. We present an outcome study of a single surgeon's experience using a modified surgical technique designed to specifically address the wide cleft palate. The surgical technique consisted of a 2-flap pushback palatoplasty without nasal mucosa closure combined with an end-to-end intravelar veloplasty and was used in cleft palates greater than or equal to 10 mm in width. A retrospective, longitudinal outcome study from chart review was then performed where age at surgery, sex, Veau classification of the cleft type, and follow-up length were recorded for each patient. Postsurgery speech outcomes were assessed by standardized speech evaluation performed by a speech language pathologist, and the presence and location of unplanned oronasal fistulas were recorded. Our study revealed an overall incidence of velopharyngeal insufficiency (VPI) of 10.8% and an unplanned symptomatic fistula rate of 16.8%. There was a significant correlation between the Veau classification of the cleft type with the incidence of both VPI and the occurrence of an unplanned oronasal fistula. Application of this surgical technique, specifically to wider cleft palates, resulted in VPI and fistula rates comparable to rates reported with other techniques used in clefts of all widths. Additional information regarding subsequent growth disturbances of the craniofacial skeleton in these patients is currently being collected.

Filling the Void: Use of the Interpositional Buccal Fat Pad to Decrease Palatal Contraction and Fistula Formation

“…[1][2][3][4][5][6][7] Of those patients with post-operative VPI, a significant percentage will require an additional surgical procedure to correct the underlying problem with rates of secondary speech surgery reported from 4.6% to 36%. 1,[3][4][5][7][8][9][10][11][12][13] This data indicates that in some hands, and depending on the threshold of the cleft surgeon and team, more than one third of patients undergoing primary palatoplasty will require a secondary operation for speech. Theoretically, higher rates of reoperation would be associated with patients that had wider and more challenging repairs.…”

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

“…Similar clinical explanations have been proposed in several studies describing the association of cleft width with surgical outcome and have been used as arguments for choosing one surgical technique over another (Landheer et al, 2010;Lin et al, 2015). In the majority of observational studies, this may represent a methodological flaw in itself because patients were often clustered for the type of surgery performed in relation to dimensions of the cleft.…”

“…Many surgical methods have been proposed to reconstruct the palate (Teblick et al, 2018), aiming for closure of the oronasal communication, reconstruction of a physiologic muscular sling, and achievement of adequate length of the velum with minimal detrimental effect on the bony growth of the maxillofacial complex (Lin et al, 2015).…”

Early outcomes of cleft and palatal width following anterior palate repair (vomerine flap) in infants with wide cleft lip and palate

“…Many surgical correction protocols are available, but there is a lack of a gold-standard protocol for palatal closure. Another issue relates to maxillary growth [1,2]. In this study, we evaluated the early effect of incorporating anterior palatal closure using a vomerine flap as a single-layer closure during lip repair.…”