Impact of Cleft Width in Clefts of Secondary Palate on the Risk of Velopharyngeal Insufficiency

Abstract

Objective To investigate the association between velopharyngeal insufficiency (VPI), a common finding after cleft palate repair, and various risk factors, including cleft width.Methods We performed a retrospective cohort study of patients with isolated cleft palates repaired from 2003 to 2008 at a tertiary children's hospital. Patients were observed postoperatively for development of VPI and palatal fistula. The primary risk factor was cleft width. Covariates included cleft length, age at surgery, and presence of associated syndrome. Logistic regression analysis was used to calculate adjusted and unadjusted odds ratios (ORs).Results The cohort comprised 61 patients. Mean (SD) patient age at the time of cleft repair was 13 (3) months. Fistula rate was 3%. Overall rate of postoperative VPI was 32%. We found significant associations between VPI diagnosis and increasing age in months at the time of palate repair (OR, 1.4 [95% CI, 1.2-1.7]) and between VPI and cleft width greater than 10 mm (OR, 5.3 [95% CI, 1.8-15.6]). The association between VPI and cleft width was similar after adjustment for cleft length, patient age, and syndrome presence (OR, 4.5 [95% CI, 1.1-18.7]).Conclusions Our results suggest that increased palatal cleft width is associated with a greater risk of postoperative VPI. Clinicians should consider this when counseling patient families for cleft palate repair.

Detailed Cleft Measurements: A Comparison between Isolated Cleft Palates and Cleft Palates Associated with Cleft Lips

“…Lam and colleagues (2012) showed that a value higher than 10 mm for b1 was associated with an increased incidence of velopharyngeal insufficiency. Their cases were repaired with a Furlow double-opposing Z-plasty or a combined Furlow palatoplasty and a V to Y pushback procedure.…”

Risk of Persistent Palatal Fistula in Patients With Cleft Palate

“…Other studies 23,24 have assessed similar outcomes and associations with preoperative cleft widths. In 2009, Parwaz et al 23 found that a width of 15 mm or greater was significantly associated with risk of fistula.…”

The Impact of Presurgical Infant Orthopedics on Oronasal Fistula Rates Following Cleft Repair: A Meta-Analysis

“…The remaining 59 articles reported a fistula rate but did not specify if PSIO was used. Twenty-six of these were excluded because the contact details of the corresponding authors were not available (Furlow, 1986; Amaratunga, 1988; Horswell et al, 1993; Senders and Sykes, 1995; Emory et al, 1997; Wilhelmi et al, 2001; Sie and Gruss, 2002; Helling et al, 2006; Ravishanker, 2006; Hassan and Askar, 2007; Andrades et al, 2008; Bindingnavele et al, 2008; Khosla et al, 2008; Steinbacher et al, 2011; Dong et al, 2012; Lam et al, 2012; Tan et al, 2012; Jackson et al, 2013; Mahoney et al, 2013; Nadjmi et al, 2013; Butow et al, 2014; Lithovius et al, 2014; Pan et al, 2014; Yamaguchi et al, 2016; Mann et al, 2017; Murthy et al). An additional 27 articles were excluded because the corresponding authors did not respond to our request to obtain the necessary data (Padwa and Mulliken, 2003; Jackson et al, 2004; LaRossa et al, 2004; Inman et al, 2005; Mak et al, 2006; Ogata et al, 2006; Kobus, 2007; Phua and de Chalain, 2008; Agrawal, 2009; Sullivan et al, 2009; Ezzat et al, 2010; Lu et al, 2010; Paniagua et al, 2010; Isik et al, 2011; Losken et al, 2011; Williams et al, 2011; Eberlinc and Kozelj, 2012; Rauf et al, 2012; Black and Gampper, 2014; de Agostino Biella Passos et al, 2014; Deshpande et al, 2014; Zhang et al, 2014; Hudson and Pickett, 2015; …”