Surgical management in submucous cleft palate patients

Abstract

Objectives The submucous cleft palate (SMCP) is considered to be the most subtle type of cleft palate. Early detection is important to allow on time intervention by speech therapy and/or surgical repair before the children already develop compensatory speech mechanisms. The purpose of this study was to investigate at what time children with a SMCP present, to determine when children are operated, and to analyze the postoperative outcomes for in SMCP children. Patient and methods Medical records from 766 individuals registered in the cleft registry in the Wilhelmina’s Children’s’ Hospital, Utrecht, were retrospectively reviewed. Inclusion criteria were children diagnosed with SMCP. The following data were collected: age at diagnosis, physical examination, age at surgery, surgical technique, speech therapy pre- and post-surgery, otitis media, secondary cleft surgery, family history, syndromes, and other anomalies. Results In total, 56 SMCP children were identified. The mean age of diagnosis was 44.0 months (range 0–150, SD = 37.0). In 48 children (85.7%), surgical intervention was performed (Furlow plasty, intravelar veloplasty, pharyngoplasty, or Furlow combined with buccal flap). Conclusion This retrospective study reconfirms that SMCP often presents late, even in a country with a modern healthcare system and adequate follow-up of all newborns by the so-called youth doctors in “children’s healthcare centers” up to the age of 4 years old. Almost 86% of patients ultimately needed palate surgery when SMCP was suspected. Clinical relevance Any child presenting with repeated episodes of otitis media, nasal regurgitation, or speech difficulties should have prompt consideration for SMCP as diagnosis.

Speech Outcomes and Velopharyngeal Function in Children Undergoing Submucous Cleft Palate Repair

“…In a reference publication, from 56 children with nonsyndromic SMCP, 32.1% were diagnosed with a syndrome and 19.6% had other anomalies. VCFS was the most common (7.1%) 14 with the same proportion of our sample.…”

“…In agreement, the other 4 publications cite age ranges between 3.7 5 and 3.9 to 7.7 years. 14 In our sample, 61% of the children underwent primary palate surgery, a slightly lower data than those of reference, at a mean age of 5.2 years. Meanwhile, there was not a significant difference between the surgical age of the group with classic (5.1 y) and occult SMCP (5.3 y).…”

“…In this sense, it has been recommended to take into account the existence of SMCP in children with speech, hearing and/or feeding problems, with repeated episodes of otitis media and nasal regurgitation. 14 However, it is not necessary to actively search for the existence of SMCP in patients without complaints. 5 In relation to the age of the first speech therapy assessment, early detection reduces the likelihood of receiving secondary surgery.…”

“…It must be considered that this figure includes classic and occult SMCP, where a statistically significant difference was observed in the diagnosis, being later in the group of children with occult SMCP (61 mo) versus the classic (38 mo), which was to be expected considering that in the first one, searchable intraoral clinical findings are not necessarily noted, but rather the suspicion is based on the nasal voice. In this sense, it has been recommended to take into account the existence of SMCP in children with speech, hearing and/or feeding problems, with repeated episodes of otitis media and nasal regurgitation 14 . However, it is not necessary to actively search for the existence of SMCP in patients without complaints 5 …”

“…In the same way, one of the main speech and language difficulties that people with some type of cleft palate present is the production of compensatory articulations (CA), which affect the linguistic system and creates a different motor engram for speech sounds production, severely impacting speech intelligibility 12,13 . Early detection is important to allow timely speech therapy intervention and/or surgical repair before children develop compensatory speech mechanisms 14 …”