title: Velopharyngeal function in nonsyndromic cleft palate: relevance of surgical technique, age at repair, and cleft type.
abstract: OBJECTIVE
  The goal of this study was to determine the relative importance of surgical technique, age at repair, and cleft type for velopharyngeal function.
  
  
  METHODS
  This was a retrospective study of patients operated on by two surgeons using different techniques (von Langenbeck and Veau-Wardill-Kilner [VY]) at Children's Hospital, Boston, MA.
  
  
  METHODS
  We included 228 patients who were at least 4 years of age at the time of review. Patients with identifiable syndromes, nonsyndromic Robin sequence, central nervous system disorders, communicatively significant hearing loss, and inadequate speech data were excluded.
  
  
  METHODS
  Need for a pharyngeal flap was the measure of outcome.
  
  
  RESULTS
  Pharyngeal flap was necessary in 14% of von Langenbeck and 15% of VY repaired patients. There was a significant linear association (p = .025) between age at repair and velopharyngeal insufficiency (VPI). Patients with an attached vomer, soft cleft palate (SCP), and unilateral cleft lip/palate (UCLP) had a 10% flap rate, whereas those with an unattached vomer, hard/soft cleft palate (HSCP), and bilateral cleft lip/palate (BCLP) had a 23% flap rate (p = .03). Age at repair was critical for the unattached-vomer group (p = .03) but was not statistically significant for the attached-vomer group (p = .52).
  
  
  CONCLUSIONS
  Surgical technique was not a significant variable either in aggregate or for the Veau types. Patients in the earliest repair group (8-10 months) were the least likely to require a pharyngeal flap. Early repair was more critical for HSCP and BCLP patients. There was no correlation between velopharyngeal insufficiency and Veau hierarchy. The attached vomer/levator muscle complex may be a more important predictor of surgical success than the anatomic extent of cleft.
authors.affiliation: Department of Medicine, Children's Hospital/Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Marrinan
authors.forename: R A
authors.initials: RA
authors.lastname: LaBrie
authors.forename: J B
authors.initials: JB
authors.lastname: Mulliken
mesh_terms: D000367:Age Factors; D016009:Chi-Square Distribution; D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D016018:Least-Squares Analysis; D009300:Nasal Septum / Q000002:abnormalities; D010043:Outcome and Process Assessment, Health Care; D010156:Palatal Muscles / Q000503:physiopathology; D010614:Pharynx / Q000601:surgery; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013524:Surgical Flaps; D014681:Velopharyngeal Insufficiency / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*