Submucous cleft palate and velopharyngeal insufficiency: comparison of speech outcomes using three operative techniques by one surgeon.
OBJECTIVE
Our purpose was to compare speech outcomes among three primary procedures for symptomatic submucous cleft palate (SMCP): two-flap palatoplasty with muscular retropositioning, double-opposing Z-palatoplasty, or pharyngeal flap.


METHODS
Retrospective review.


METHODS
Tertiary hospital.


METHODS
All children with SMCP treated by the senior author between 1984 and 2008.


METHODS
One of three primary procedures: two-flap palatoplasty with muscular retropositioning, double-opposing Z-palatoplasty, or pharyngeal flap.


METHODS
Speech outcome and need for a secondary operation were analyzed among procedures. Success was defined as normal or borderline competent velopharyngeal function. Failure was defined as persistent borderline insufficiency or velopharyngeal insufficiency with recommendation for a secondary operation.


RESULTS
We identified 58 patients with SMCP who were treated for velopharyngeal insufficiency. We found significant differences in median age at operation among the procedures (p < .001). Two-flap palatoplasty with muscular retropositioning (n = 24), double-opposing Z-palatoplasty (n = 19), and pharyngeal flap (n = 15) were performed at a median of 2.5, 3.6, and 9.5 years, respectively. There were significant differences in success among procedures (p = .018). Normal or borderline competent function was achieved in 6/20 (30%) patients who underwent two-flap palatoplasty, 10/15 (67%) following double-opposing Z-palatoplasty, and 11/12 (92%) following pharyngeal flap. Among patients treated with palatoplasty, success was independent of age at operation (p = .16).


CONCLUSIONS
Double-opposing Z-palatoplasty is more effective than two-flap palatoplasty with muscular retropositioning. For children older than 4 years, primary pharyngeal flap is also highly successful but equally so as a secondary operation and can be reserved, if necessary, following double-opposing Z-palatoplasty.
Sullivan
Stephen R
SR
Vasudavan
Sivabalan
S
Marrinan
Eileen M
EM
Mulliken
John B
JB
D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013064:Speech Disorders / Q000503:physiopathology*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*