Association Between Palatal Index and Cleft Palate Repair Outcomes in Patients With Complete Unilateral Cleft Lip and Palate

Abstract

IMPORTANCE This study evaluates a technique to estimate cleft severity and tissue hypoplasia in patients with cleft palate. Current classifications are limited to the morphologic characterstics of the clefts. A new classification is proposed in relation to the palatal index, which allows more individualized surgical attention for the cleft palate. OBJECTIVE To evaluate the relationship of palatal index and cleft palate repair surgical outcomes (palatal fistula and velopharyngeal insufficiency) in patients with unilateral cleft lip and palate. DESIGN, SETTING, AND PARTICIPANTS Retrospective study performed by the Outreach Surgical Center Program Lima, Lima, Perú, of surgical outcomes of 152 consecutive pediatric patients, aged 12 to 15 months, with nonsyndromic unilateral complete cleft lip and palate treated during from 2001 to 2007. Findings were obtained at 1 to 5 years' follow-up. INTERVENTIONS Palatoplasty using the 2-flap technique plus intravelar veloplasty. Palate index was measured preoperatively with the patient under general anesthesia. MAIN OUTCOMES AND MEASURES Postoperative analysis via the χ 2 test to assess the statistical significance of association between the palatal index and surgical outcomes. RESULTS Palatal fistula rates correlated directly with the cleft severity, as estimated by the palatal index (P = .01), but there was no association between postoperative velopharyngeal insufficiency and palatal index (P = .76). CONCLUSIONS AND RELEVANCE The palatal index was a good predictor of fistula development in the studied group. There was an association between the cleft severity and tissue deficiency (estimated using this index) and presence of palatal fistula. Further long-term study is needed to evaluate the relationship between the palatal index and maxillary growth. LEVEL OF EVIDENCE 4.

One-flap Palatoplasty

“…The original illustration of Bardach shows a surgical closure without raw lateral surfaces, which is not technically feasible with wider clefts (moderate to severe palatal index). 17 …”

“…All instances were gauged according to cleft severity (based on palatal index) as follows: mild (<0.2), moderate (0.2–0.4), and severe (>0.4). 17 Palatal index is the proportion between width of cleft (cleft severity) and the sum of both palatal segment widths (tissue deficiency) measured at the junction of hard and soft palates.…”

Nuevo enfoque en el tratamiento quirúrgico de las fisuras palatinas congénitas

“…La mayoría de artículos publicados hasta la fecha en-focan la fisura palatina en función del segmento anatómico involucrado (clasificación de Veau), lo cual no ilustra adecuadamente estas patologías debido a que dos fisuras palatinas con el mismo segmento afecto, no son iguales y pueden presentar un grado de severidad diferente al tener las fisuras con diámetros diferentes (2)(3)(4). Estudios anteriores realizados por nosotros mismos nos han permitido desarrollar instrumentos para valorar el grado de severidad de las fisuras, tales como el diagrama de reloj y el índice de fisura palatina (5)(6)(7). Así, determinamos la severidad de la fisura palatina combinando la clasificación de Veau con el índice de fisura palatina propuesto por nosotros (6,7).…”

“…Estudios anteriores realizados por nosotros mismos nos han permitido desarrollar instrumentos para valorar el grado de severidad de las fisuras, tales como el diagrama de reloj y el índice de fisura palatina (5)(6)(7). Así, determinamos la severidad de la fisura palatina combinando la clasificación de Veau con el índice de fisura palatina propuesto por nosotros (6,7).…”

“…b) Mayor probabilidad de desarrollar hipoplasia maxilar secundaria a la cirugía primaria palatina (10)(11)(12). c) Limitación para tratar formas severas de fisuras palatinas, en las que se observa una mayor proporción de fístulas palatinas con esta técnica (6,7).…”