Current surgical techniques for cleft lip-palate in Minas Gerais, Brazil

Paranaíba, Lívia Máris Ribeiro; Almeida, Hudson de; Barros, Letízia Monteiro de; Martelli, Daniella Reis Barbosa; Júnior, Julian Dias Orsi; Júnior, Hercílio Martelli

doi:10.1016/s1808-8694(15)30546-2

Cited by 5 publications

(2 citation statements)

References 15 publications

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“…Technique and timing of cleft palate repair are important concepts to ensure good outcomes, but there is no consensus on either. 76 Cleft palate repair variations differ between surgeons and cleft centers worldwide. Original techniques are often modified and combined to create variations, such as the combination of Von Langenbeck’s procedure with other techniques to reconstruct the velopharyngeal muscle sling or lengthen the palate.…”

Section: Discussionmentioning

confidence: 99%

Cleft Palate Repair: A History of Techniques and Variations

Yao

Chong

Magee

2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Orofacial clefting is a common reconstructive surgical condition that often involves the palate. Cleft palate repair has evolved over three centuries from merely achieving anatomical closure to prioritizing speech development and avoiding midface hypoplasia. Despite centuries of advancements, there is still substantial controversy and variable consensus on technique, timing, and sequence of cleft palate repair procedures. Furthermore, evaluating the success of various techniques is hindered by a lack of universal outcome metrics and difficulty maintaining long-term follow-up. This article presents the current controversies of cleft palate repair and details how the history of cleft palate repair has influenced current techniques commonly used worldwide. Our review highlights the need for a global consortium on cleft care to gather expert opinions on current practices and outcomes and to standardize technique classifications. An understanding of global protocols is crucial in an attempt to standardize technique and timing to achieve anatomical closure with optimal velopharyngeal competence, while also minimizing the occurrence of maxillary hypoplasia and palatal fistulae.

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Section: Discussionmentioning

confidence: 99%

Cleft Palate Repair: A History of Techniques and Variations

Yao

Chong

Magee

2022

Plastic and Reconstructive Surgery - Global Open

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“…17 There is still no international consensus on the appropriate timing of cleft palate repair and technique preferences are still debated. 18,19 Most literature suggests primary palatoplasty performed after 18 months leads to worse speech and a higher risk of developing VPI. 9,[20][21][22][23][24] However, some centers still advocate for delayed palatoplasty to limit midface hypoplasia.…”

mentioning

confidence: 99%

Systematic Review of Postoperative Velopharyngeal Insufficiency: Incidence and Association With Palatoplasty Timing and Technique

Xepoleas,

Naidu,

Nagengast

et al. 2023

Journal of Craniofacial Surgery

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Cleft palate is among the most common congenital disorders worldwide and is correctable through surgical intervention. Sub-optimal surgical results may cause velopharyngeal insufficiency (VPI). When symptomatic, VPI can cause hypernasal or unintelligible speech. The postoperative risk of VPI varies significantly in the literature but may be attributed to differences in study size, cleft type, surgical technique, and operative age. To identify the potential impact of these factors, a systematic review was conducted to examine the risk of VPI after primary palatoplasty, accounting for operative age and surgical technique. A search of PubMed, Embase, and Web of Science was completed for original studies that examined speech outcomes after primary palatoplasty. The search identified 4740 original articles and included 35 studies that reported mean age at palatoplasty and VPI-related outcomes. The studies included 10,795 patients with a weighted mean operative age of 15.7 months (range: 3.1–182.9 mo), and 20% (n=2186) had signs of postoperative VPI. Because of the heterogeneity in reporting of surgical technique across studies, small sample sizes, and a lack of statistical power, an analysis of the VPI risk per procedure type and timing was not possible. A lack of data and variable consensus limits our understanding of optimal timing and techniques to reduce VPI occurrence. This paper presents a call-to-action to generate: (1) high-quality research from thoughtfully designed studies; (2) greater global representation; and (3) global consensus informed by high-quality data, to make recommendations on optimal technique and timing for primary palatoplasty to reduce VPI.

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