title: Submucous cleft palate: outcomes after primary repair with repositioning of the levator muscle in 51 consecutive patients.
abstract: I report the incidence of hypernasal resonance, nasal emission, and fistula after intravelar surgery with retropositioning of the levator muscle by a single surgeon in a consecutive series of 51 patients who presented with symptomatic submucous cleft palate. Intravelar veloplasty with repositioning of the levator muscle was highly effective in that 37/51 patients (73%) achieved either normal or mild and inconsistent resonance (p<0.0001), and 39 (77%) normal or mild and inconsistent nasal emissions (p<0.0001). The fistula rate was 6% (n=3). Both the clinical grade of submucous cleft palate and the presence of a syndrome correlated directly with changes in hypernasality, whereas the age of the patient and the degree of hypernasality at presentation did not. Non-syndromic patients with clinical grade III and II submucous cleft palates responded well to intravelar surgery with repositioning of the levator muscle, and routine preoperative videofluoroscopy is not recommended. I recommend intravelar surgery with repositioning of the levator muscle routinely for all non-syndromic patients who present with grade III or II submucous cleft palate and velopharyngeal insufficiency.
authors.affiliation: Consultant Cleft, Oral and Maxillofacial Surgeon, Northern and Yorkshire Cleft Lip and Palate Service, Leeds General Infirmary, Great George Street, West Yorkshire, LS1 3EX. Electronic address: Alistair.smyth@leedsth.nhs.uk.
authors.forename: A G
authors.initials: AG
authors.lastname: Smyth
mesh_terms: D002972:Cleft Palate / Q000601:surgery*; D005402:Fistula / Q000209:etiology / Q000601:surgery; D006801:Humans; D009668:Nose Diseases; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency
keywords: Clinical grade; Intravelar surgery; Submucous cleft palate; Velopharyngeal insufficiency