The effect of hamulus fracture on the outcome of palatoplasty: a preliminary report of a prospective, alternating study.
OBJECTIVE
To determine whether, in performing palatoplasty, fracture of the pterygoid hamulus is beneficial, detrimental, or neutral with respect to intraoperative and perioperative complications, hearing outcome, and speech outcome.


METHODS
Prospective, alternating.


METHODS
Institutional, tertiary cleft palate center, Chang Gung Memorial Hospital, Taipei, Taiwan.


METHODS
A total of 173 patients enrolled in the study, of whom 161 had charts available for analysis.


METHODS
During the performance of palatoplasty, 85 patients received hamulus fracture and 76 patients did not. All palatoplasties were performed by the same surgeon.


METHODS
(1) Surgical outcomes, including patient demographic data, palatoplasty type and duration, blood loss, incidences of oronasal fistulae, temporary mucosal dehiscence, and postoperative bleeding; (2) otolaryngological outcomes, including hearing results as judged by auditory brainstem response testing, myringotomy tube data describing rates of tube extrusion, and culture results from sampled effusions; and (3) preliminary speech outcomes as described by judgments of overall velopharyngeal function from perceptual speech samples.


RESULTS
No statistically significant differences in any of the measured surgical, otolaryngological, or preliminary speech outcomes were found between the groups who did and did not receive hamulus fracture.


CONCLUSIONS
On the basis of these results, we are unable to advocate the performance of hamulus fracture as an operative maneuver during the performance of primary palatoplasty. The historical rationale and theoretical advantage of this maneuver have not been demonstrated here nor have any detrimental effects of the maneuver been measured.
Kane
A A
AA
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
Lo
L J
LJ
Yen
B D
BD
Chen
Y R
YR
Noordhoff
M S
MS
D016009:Chi-Square Distribution; D002972:Cleft Palate / Q000601:surgery*; D016057:Evoked Potentials, Auditory, Brain Stem; D006320:Hearing Tests; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D010034:Otitis Media with Effusion / Q000209:etiology / Q000382:microbiology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011300:Preoperative Care; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D013068:Speech Production Measurement; D013100:Sphenoid Bone / Q000601:surgery*