Palatal cleft: Results after 18 years, one surgeon, one primary technique

Abstract

This study reviews the results after 18 years of our surgery and follow-up for children born in our hospital with a cleft palate (CP). Evaluation of 18-year-old youngsters born with CP, operated at the time by the same surgeon following the same primary surgical procedure (von Langenbeck). We analyzed the files of children born from 1997 to 2001 with a CP and operated in our hospital. Operations were performed by the same surgeon, following the von Langenbeck procedure adapted according to the children's age or weight. The evaluation was based on the results of the primary surgeries, final phonatory results, otorhinolaryngology interventions, maxillofacial surgery, and psychological needs. All syndromic children were excluded. Seventy-nine files from children born with a cleft were reviewed: 34 were taken into consideration and among them five Pierre Robin Sequence (PRS) were removed. Children were operated at a median age of 5,2 months (3-6). Eighteen percent had a fistula, 45% had grommets, 14% were operated for a pharyngeal flap following the Sanvenero-Rosselli technique to improve the phonatory score. Thirty-six (36) percent had a final phonation I, 32% a phonation I/II and 32% a phonation IIb. None had an osteotomy. All children were seen by our psychologist. A median of 5.5 multidisciplinary consultations were affected with a median number of general anesthesia of 2.4 (1-6).This retrospective study is based on one primary surgical technique used by the same surgeon. It shows that the von Langenbeck procedure done at six months entails a certain risk of fistula but shows good long-term phonatory results. The number of grommets used is low and must be seen in relation with otitis media and our follow-up. A few complements to our investigations and follow-up are proposed concerning grommets, surgical procedures, and sleep disorder.

What We Learned from Performing the Inverse Malek Procedure to Repair Bilateral Cleft Lips and Palates: A Single-Center Retrospective Study

“…Pharyngoplasty is required when primary repair surgery results in insufficient velopharyngeal function. The surgical procedures include lengthening of the palate [23,52] (pushback palatoplasty, Furlow double-opposing z-plasty, and pharyngeal flap, with the latter commonly used in our center since 2014), sphincter pharyngoplasty, and the enlargement of the posterior pharyngeal wall with injectable materials (autologous fat or hyaluronic acid) [53][54][55]. Pharyngeal flaps can be based superiorly, inferiorly, or laterally [56].…”

“…Children with a BLCP are subject to a delayed speech development due to the palatal cleft. Assessments can be performed either subjectively, by a speech therapist, or using pressure-flow technology measurement [23,61]. In our center, as in many other Frenchspeaking institutions [25], we evaluate speech or nasal air emission based on the Borel-Maisonny classification.…”

“…A removable palatal appliance made of acrylic resin was built by the orthodontist soon after birth. The prosthesis had a rigid outer part and a softer more flexible inner layer that is in contact with the mucosa [23] (Figure 2). Then, a normal feeding bottle with a larger opening allowed the milk to run easily.…”

“…The concept of a multidisciplinary team is essential for a good and correct follow-up. The objective is to bring together specialists, i.e., pediatric plastic surgeons, maxillofacial surgeons, ear, nose, and throat (ENT) surgeons, speech therapists, nurses, and psychologists [5,9,23], to optimize the care and the functional and esthetic outcomes. This also requires the collaboration of obstetricians and geneticists.…”

Unilateral Cleft lip and Palate: Long-Term Results of the Malek Technique

“…A facial cleft can be labial, labio-maxillary (unilateral or bilateral), labio-maxillary-palatal (unilateral or bilateral), or isolated palatal. 1 Depending on the type of cleft and the age of the child, feeding, speech, ear-nose-throat (ENT), dental, orthodontic, aesthetic, and psychological problems will be present. 2,3 Unilateral cleft of the lip and palate (uCLP) is the most common type and represents 37% to 50% of all cases of clefts.…”