Submucous Cleft Palate: Diagnostic Methods and Outcomes of Surgical Treatment

Abstract

The following statements summarize our interpretation of the literature regarding submucous cleft palate: Incidence and Diagnosis of Submucous Cleft Palate 1. In surveys of classic stigmata of submucous cleft palate among the general population, the incidence has been reported to be 0.02 to 0.08 percent. In the larger of these series, the incidence of velopharyngeal inadequacy among patients identified to have submucous cleft palate was 1 to 9. The incidence of occult submucous cleft palate is not known, since these patients will only be detected during the evaluation of patients who present with velopharyngeal inadequacy. 2. The diagnosis of submucous cleft palate is made by identification of the classic stigmata on physical examination. The diagnosis of occult submucous cleft palate is only pursued if the patient has velopharyngeal inadequacy. 3. For consistency in evaluating and reporting data, patients with an overt cleft of the secondary palate that extends beyond the uvula should be reported as having a cleft palate, and not a submucous cleft palate, even if a submucous cleft exists in a portion of the palate anterior to the overt cleft. 4. The true incidence of otitis media with effusion in the presence of submucous cleft palate has yet to be determined using a prospective study. Surgical Treatment of Velopharyngeal Inadequacy in Patients with Submucous Cleft Palate 1. The technique that has most consistently been documented to result in a significant correction of velopharyngeal inadequacy is the pharyngeal flap. There is recent evidence from one large center supporting the efficacy of the Furlow Z-plasty in selected patients with submucous cleft palate. Both these procedures appear to be most effective in patients with good lateral pharyngeal wall motion. 2. If a pharyngeal flap is performed as the primary procedure to act as an obturator against which the lateral pharyngeal walls appose for closure, we do not see the need for adjunctive palatal procedures. The dynamic component of velopharyngeal competence following such a pharyngeal flap consists of lateral wall motion, which is not enhanced by further surgical manipulation of the palate. However, a pharyngeal flap may be performed as an adjunctive procedure to a palatal pushback in order to provide lining for the resultant defect in the nasal mucosa. 3. The present literature does not support "prophylactic" operations on patients who present with the physical stigmata of submucous cleft palate prior to reaching an age at which it can be demonstrated by perceptual speech assessment that velopharyngeal inadequacy remained refractory to speech therapy. A significant number of patients will never develop velopharyngeal inadequacy; therefore, surgery would be unnecessary. In addition, objective data regarding the outcomes of different surgical techniques cannot be gathered if patients with submucous cleft palate are operated on without having had velopharyngeal inadequacy documented prior to those operations. 4. In order to objectively compare the outcomes...

Ultrasound imaging to identify occult submucous cleft palate

“…Several studies have shown that speech outcomes are affected by patient age at the time of surgery. 3,9,10 Unfortunately, submucous cleft palate is often identified late. McWilliams reported only 36% of patients with a submucous cleft palate were diagnosed by 4 years of age, and 24% were diagnosed between 8 and 20 years of age.…”

“…14 With the incidence of bifid uvula reported to be between 1% and 7.5%, this suggests that the incidence of occult submucous cleft palate may be higher than appreciated. 3 Another study compared a group of 25 children with an isolated cleft lip not extending into the secondary palate with a control group of 25 children without a known facial cleft. 7 No patients in the control group were identified to have submucous cleft palate.…”

“…3 Many children with a submucous cleft palate likely go undetected, either because the cleft is missed on physical examination or the child is asymptomatic and never examined. A delay in diagnosis can have longterm consequences on speech development.…”

Cleft Lip and Palate: Etiology, Epidemiology, Preventive and Intervention Strategies

“…Another dilemma in the reporting of OFCs is that some studies include all births in the rate calculations while others include only live births. Since clefts are more frequent among stillborn and spontaneously aborted infants, their inclusion in the denominator impact the results significantly [29][30][31]. The IPDTOC Working Group, 2011 have summarized the conclusions of all recent epidemiologic data on OFC as follows [32,33]:…”

Caracterização fenotípica em indivíduos com microarranjos na região cromossômica 22q11

“…A fenda submucosa de palato (FPSM), é um subgrupo de fendas labiopalatinas,que apresenta uma prevalência de 1:1250 -1:6000 (GOSAIN et al, 1996 VELASCO et al, 1988). A investigação auditiva deve ser realizada com triagem auditiva neonatal e com uma segunda triagem por volta dos cinco anos de idade (HABEL et al, 2014).…”