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Method of Studying Palatal Fusion using Static Organ Culture
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Isolated cleft palate requires different surgical protocols depending on cleft type.

Anna Elander1, Christina Persson2, Jan Lilja1

  • 1a Institute of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska Academy , University of Gothenburg , Sweden.

Journal of Plastic Surgery and Hand Surgery
|October 19, 2016
PubMed
Summary

This study shows a staged protocol for cleft palate repair is safe, with few secondary surgeries needed. However, hard palate clefts and additional conditions negatively impact speech outcomes.

Keywords:
Isolated cleft palatemalformationsoft and hard palate

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Area of Science:

  • Craniofacial Surgery
  • Pediatric Surgery
  • Plastic Surgery

Background:

  • Cleft palate (CP) is a common congenital condition, often associated with other malformations.
  • Current surgical protocols aim to optimize outcomes, including maxillary growth and velopharyngeal function.
  • A staged protocol involving early soft palate repair and delayed hard palate repair was introduced to improve maxillary growth.

Purpose of the Study:

  • To evaluate a staged surgical protocol for cleft palate repair (CP) in terms of primary and secondary interventions.
  • To assess the need for surgical interventions for cleft closure and velopharyngeal insufficiency until age 10.
  • To determine the impact of cleft type and additional malformations on surgical outcomes and velopharyngeal function.

Main Methods:

  • Retrospective analysis of 94 consecutive children with cleft palate (CP).
  • Patients were divided into four groups based on cleft location (soft palate only or hard and soft palate) and presence of additional malformations.
  • Surgical interventions, including hard palate repair and secondary velopharyngeal surgery, were recorded until age 10.

Main Results:

  • Hard palate repair was required in 53% of patients.
  • The overall incidence of fistula repair was 5%, and soft palate re-repair was 2%.
  • Secondary velopharyngeal surgery was needed in 17% of cases, with higher rates in patients with hard palate involvement and additional malformations (up to 30%).

Conclusions:

  • The staged protocol for cleft palate repair is safe, with low rates of re-operation and fistula formation.
  • The presence of a cleft in the hard palate and/or additional congenital conditions negatively impacts velopharyngeal function development.
  • The staged protocol demonstrates favorable perioperative results and a manageable need for secondary interventions.