The submucous cleft palate: diagnosis and therapy

Area of Science:

• Craniofacial Surgery
• Pediatric Otolaryngology
• Speech Pathology

Background:

• Submucous cleft palate (SMCP) presents diagnostic challenges, often leading to delayed identification.
• Key indicators include hypernasal speech and Eustachian tube dysfunction, frequently associated with palatal anomalies like bifid uvula.

Purpose of the Study:

• To analyze the diagnostic age, presenting symptoms, palatal findings, and treatment outcomes for SMCP.
• To evaluate the efficacy of the butterfly suture veloplasty technique in managing velopharyngeal insufficiency.

Main Methods:

• Retrospective analysis of 439 patients diagnosed with symptomatic SMCP.
• Surgical intervention involved the butterfly suture veloplasty technique, often combined with adenotomy and ventilation tube insertion.

Main Results:

• Mean age at diagnosis was 4.9 years.
• Hypernasal speech (51%) and conductive hearing loss (45%) were primary symptoms, resolving post-surgery.
• Palatal findings included lack of posterior nasal spine (68%) and bifid uvula (59%).
• 17.1% required speech therapy and 5.5% needed velopharyngoplasty for persistent hypernasal speech.

Conclusions:

• SMCP is frequently diagnosed late, despite characteristic symptoms and palatal findings.
• Early specialist evaluation by Phoniatrics, Otolaryngologists, and Oral-Maxillofacial-Surgeons is crucial for timely diagnosis and palatoplasty.
• The butterfly suture veloplasty is a safe and effective treatment for velopharyngeal insufficiency in symptomatic SMCP patients.