Palatoplasty Outcomes in Nonsyndromic Patients With Cleft Palate

Abstract

The primary objective of cleft palate repair is velopharyngeal competence without fistula. The reported incidence of fistula and velopharyngeal insufficiency (VPI) is variable. Our purpose was to assess the senior surgeon's 29-year palatoplasty experience with respect to incidence of fistula and VPI. Our hypotheses were that VPI is related to (1) age at palatoplasty, (2) cleft palate type, and (3) VPI and palatal fistula incidence decrease with the surgeon's experience. We reviewed the records of all children with cleft palate treated by the senior author between 1976 and 2004. Cleft palate was categorized according to Veau. Palatoplasty was performed on 449 patients, using a 2-flap technique with muscular retropositioning. The mean age at palatoplasty was 11.6 +/- 4.9 months (range, 7.0-46.4 months). The incidence of palatal fistula was 2.9%, and velopharyngeal sufficiency was found in 85.1% of patients. We found a significant association between age at palatoplasty and VPI (P = 0.009, odds ratio, 1.06 [95% confidence interval, 1.02-1.10]). Velopharyngeal insufficiency was also associated with the Veau hierarchy (P = 0.001). Incidence of VPI was independent of surgeon experience (P = 0.2). In conclusion, the incidence of palatal fistula was low. Velopharyngeal insufficiency was associated with increasing age at palatoplasty and with the Veau hierarchy.

Prospective Analysis of Presurgical Risk Factors for Outcomes in Primary Palatoplasty

“…Although the presence of velopharyngeal insufficiency requiring secondary surgery has been shown to follow the Veau hierarchy, 1,[8][9][10][11] other reports have found the highest incidences in isolated cleft palate (Veau I and II). [12][13][14][15][16][17] Conversely, Marrinan et al could find no correlation between velopharyngeal insufficiency and Veau hierarchy.…”

Timeliness of surgical care in children with special health care needs: delayed palate repair for publicly insured and minority children with cleft palate

“…The American Cleft Palate-Craniofacial Association advocates repair by 18 months in a normally developing infant [8]. Certain centers support earlier repair to reduce the risk of velopharyngeal insufficiency, which has been shown to increase by 6% for each month the repair is delayed beyond 7 months [9,10].…”

Evidence-Based Medicine

“…Repositioning of the levator sling and recreation of the normal anatomy results in velopharyngeal competence for most patients and reduces the need for secondary pharyngeal flaps. 27 In a study by Sullivan et al, 28 persistent postoperative velopharyngeal insufficiency was shown to be associated with patient age at palatoplasty (timing), and degree of palatal involvement (Veau score) (Level of Evidence: Therapeutic/ Prognostic, IV). They conclude that early, singlestage repair reduces the development of learned, compensatory misarticulations that can persist despite surgical correction of the palatal anatomy, but must be weighted against altered facial growth secondary to early disruption of the maxillary periosteum and soft-tissue envelope.…”