The effect of age at surgery and compensatory articulation on speech outcome in submucous cleft palate patients treated with double-opposing Z-plasty: A 10-year experience.
BACKGROUND
Submucous cleft palate is a congenital deformity that may present as velopharyngeal insufficiency. The degree of anatomical abnormality varies widely among patients and does not predict severity of symptom. We present our 10-year experience treating submucous cleft palate patients with double opposing z-plasty and explore the effect of age at surgery and compensatory articulation on speech.


METHODS
Preoperative assessment included intraoral examination, nasoendoscopy, and perceptual speech evaluation. Age, gap size, and severity of hypernasality were assessed to determine the timing and type of surgery. A retrospective study of 74 submucous cleft palate patients undergoing double-opposing z-plasty from 2005 to 2016 by a single surgeon (Baek RM) was conducted. Double opposing z-plasty was modified to fully release all abnormal insertions of the levator veli palatini muscle. Postoperative velopharyngeal function was measured and statistical analyses were performed.


RESULTS
The ages of patients at surgery ranged from 11 months to 19 years. Postoperatively 87 percent of the patients achieved velopharyngeal competency and 13 percent had remaining mild hypernasality. Age was a significant factor in predicting speech outcome, and patients receiving surgery prior to the age of 5.5 years had a higher normalization rate. Compensatory articulation did not have an impact on postoperative hypernasality. There were no cases of postoperative hyponasality or airway problems.


CONCLUSIONS
Satisfactory speech outcome was achieved with the authors' protocol and modification of the double-opposing z-plasty. A comprehensive assessment of patient age, intraoral findings, severity of hypernasality, and gap size, is necessary for proper treatment of submucous cleft palate patients.
Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi Ro 173 Road 82, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
Rong-Min
RM
Baek
Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi Ro 173 Road 82, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
Baek-Kyu
BK
Kim
Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi Ro 173 Road 82, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
Jae Hoon
JH
Jeong
Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi Ro 173 Road 82, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
Taeseon
T
Ahn
Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi Ro 173 Road 82, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea. Electronic address: slpmikyongpark@hanmail.net.
Mikyong
M
Park
Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi Ro 173 Road 82, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea. Electronic address: jollyjulie@gmail.com.
Jihyeon
J
Han
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control; D012189:Retrospective Studies; D013060:Speech / Q000502:physiology*; D013064:Speech Disorders / Q000517:prevention & control; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000503:physiopathology / Q000601:surgery; D055158:Velopharyngeal Sphincter / Q000502:physiology; D055815:Young Adult
Age; Compensatory articulation; Double opposing z-plasty; Hypernasality; Submucous cleft palate; Velopharyngeal insufficiency