Long-term results following the repair of palatal clefts: a comparison of three different techniques

A series of 109 patients was divided according to type of palatal defect, technique of repair (pushback, von Langenbeck, or pushback with island flap), results of standardized multifactorial speech analyses, and effectiveness of primary and secondary operations. Sixty-five patients (60 percent) showed improved speech after the initial repair, with 49 of these rated as "good." Forty-five percent improved after the von Langenbeck operation, 57 percent improved after the pushback procedure, and 53 percent improved after the pushback/island flap repair. Persistent hypernasal speech was treated with superiorly based pharyngeal flaps in 18 patients with uniform success (p less than or equal to 0.001). The worst results (after all three techniques) followed the repair of bilateral complete clefts. This experience has tempered our expectations in dealing with cleft palate patients, especially those having bilateral defects.