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Method of Studying Palatal Fusion using Static Organ Culture
Published on: September 19, 2015
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.
Insights
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.
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.
Abstract:
A staged protocol for isolated cleft palate (CPO), comprising the early repair of the soft palate at 6 months and delayed repair of the eventual cleft in the hard palate until 4 years, designed to improve maxillary growth, was introduced. CPO is frequently associated with additional congenital conditions. The study evaluates this surgical protocol for clefts in the soft palate (CPS) and for clefts in the hard and soft palate (CPH), with or without additional malformation, regarding primary and secondary surgical interventions needed for cleft closure and for correction of velopharyngeal insufficiency until 10 years of age. Of 94 consecutive children with CPO, divided into four groups with (+) or without (-) additional malformations (CPS + or CPS - and CPH + or CPH-), hard palate repair was required in 53%, performed with small local flaps in 21% and with bilateral mucoperiosteal flaps in 32%. The total incidence of soft palate re-repair was 2% and the fistula repair of the hard palate was 5%. The total incidence of secondary velopharyngeal surgery was 17% until 10 years, varying from 0% for CPS - and 15% for CPH-, to 28% for CPS + and 30% for CPH+. The described staged protocol for repair of CPO is found to be safe in terms of perioperative surgical results, with comparatively low need for secondary interventions. Furthermore, the study indicates that the presence of a cleft in the hard palate and/or additional conditions have a negative impact on the development of the velopharyngeal function.
