Prospective analysis of presurgical risk factors for outcomes in primary palatoplasty

The authors present a single surgeon's series of primary palatoplasty over a 10-year period in order to determine which presurgical factors might influence postoperative fistula rate and speech outcome.

Data were prospectively acquired for all patients undergoing primary palatoplasty between January of 2000 and January of 2010. Standard demographic data were captured together with classification of cleft type and severity (as defined by palate length and cleft width). Outcome data were assessed in terms of fistula rate and the requirement for secondary speech surgery for velopharyngeal insufficiency.

There were 485 primary procedures; 276 patients were male. Mean age at primary surgery was 20.4 months. Clefts were classified according to Kernahan and Stark (cleft palate, n = 260; cleft lip/palate, n = 225) and Veau class (I, n = 85; II, n = 175; III, n = 165; and IV, n = 60). Palate length was assessed according to Randall's classification (I, n = 81; II, n = 319; III, n = 58; IV, n = 2). Mean palate width was 7.7 mm (range, 0 to 19 mm). Cleft lip/palate was associated with wider mean cleft width and a higher incidence of shorter palates than cleft palate. Velopharyngeal insufficiency was more frequent in cleft lip/palate than in cleft palate. Male sex, greater cleft width, and shorter palate length were independent predictors of velopharyngeal insufficiency.

Distributions of sex, cleft width, and palate length vary among the differing cleft types and may explain some of the variation in outcomes among centers and protocols. These data should be recorded to facilitate valid comparisons among future studies.

Risk, III.