A comparison of three methods of repairing the hard palate.
OBJECTIVE
To compare growth, speech, and nasal symmetry outcomes of three methods of hard palate repair.


METHODS
Consecutive available records of children born with unilateral bony complete cleft lip and palate over the period 1972 to 1992.


METHODS
Identical management of lip, nose, alveolus, and soft palate. Hard palate repair by Cuthbert Veau (CV) from 1972 to 1981, von Langenbeck (vL) from 1982 to 1989, or medial Langenbeck (ML) from 1989 to 1991.


METHODS
For growth: GOSLON yardstick or 5-year model index. For speech: articulation test. Nasal anemometry. For nasal symmetry: Coghlan computer-based assessment. All these measures were developed during the period of data collection but not for this project.


RESULTS
There was a strong trend toward more favorable anteroposterior maxillary growth with the change from CV to vL to ML techniques. This fell short of statistical significance because of the small sample size. There was a significant reduction in cleft-related articulation faults (p =.01) considered to be related to improved arch form. In the absence of improved rates of velopharyngeal insufficiency or nasal symmetry, increased surgical experience was discounted as a significant contribution to improved growth and articulation outcomes.


CONCLUSIONS
Reduced periosteal undermining and residual exposed palatal shelf from CV to vL to ML improved incisor relationships and articulation.
Pigott
R W
RW
Department of Speech and Language Therapy, Frenchay Healthcare NHS Trust, Frenchay Hospital, Bristol, United Kingdom.
Albery
E H
EH
Hathorn
I S
IS
Atack
N E
NE
Williams
A
A
Harland
K
K
Orlando
A
A
Falder
S
S
Coghlan
B
B
D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008437:Maxilla / Q000254:growth & development; D009666:Nose / Q000473:pathology; D016155:Oral Fistula / Q000209:etiology / Q000601:surgery; D019647:Oral Surgical Procedures / Q000379:methods*; D021362:Palate, Hard / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D013062:Speech Articulation Tests; D013524:Surgical Flaps; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology; D014833:Voice Quality