title: We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients.
abstract: OBJECTIVE
  To find an anatomical measurement of the cleft palate (or a calculated parameter) that predicts the occurrence of velopharyngeal insufficiency (VPI) after palatal cleft repair.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Charts were reviewed from cleft palate patients who underwent palatoplasty by the Von Langenbeck technique for isolated cleft palate or Bardach two-flap palatoplasty for cleft lip-palate. Seven anatomical cleft parameters were prospectively measured during the palatoplasty procedure. Three blinded speech-language pathologists retrospectively scored the clinically assessed VPI at 4 years of age. The recommendation of pharyngoplasty was also used as an indicator of VPI.
  
  
  RESULTS
  From 1993 to 2008, 67 patients were enrolled in the study. The best predicting parameter was the ratio a/(30 - b1), in which a is defined as the posterior gap between the soft palate and the posterior pharyngeal wall and b1 is the width of the cleft at the hard palate level. An a/(30 - b1) ratio >0.7 to 0.8 is associated with a higher risk of developing VPI (relative risk = 2.2-5.1, sensitivity = 72%-81%, P < .03).
  
  
  CONCLUSIONS
  The width of the cleft at the hard palate level and the posterior gap between the soft palate and the posterior pharyngeal wall were found to be the most significant parameters in predicting VPI. The best correlation was obtained with the ratio a/(30 - b1).
  
  
  METHODS
  4.
authors.affiliation: Quebec University Hospital Center (CHUQ), Quebec City, Quebec, Canada.
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Leclerc
authors.forename: Audrey
authors.initials: A
authors.lastname: Godbout
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arteau-Gauthier
authors.forename: Sophie
authors.initials: S
authors.lastname: Lacour
authors.forename: Kati
authors.initials: K
authors.lastname: Abel
authors.forename: Elisa-Maude
authors.initials: EM
authors.lastname: McConnell
mesh_terms: D001837:Body Weights and Measures; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010159:Palate / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D014681:Velopharyngeal Insufficiency / Q000209:etiology*
keywords: Cleft palate; hypernasality; palatoplasty; pharyngoplasty; velopharyngeal dysfunction; velopharyngeal insufficiency